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DRESS syndrome with pancreatitis and hepatitis: 2 case reports Two patients developed DRESS syndrome with pancreatitis and hepatitis following treatment with lamotrigine and allopurinol, respectively. A 23-year-old woman with a history of borderline personality disorder and depression received lamotrigine [therapeutic indication, dosage and route not stated] starting 10 days prior to presentation. She presented with fever, body aches, nausea, vomiting, abdominal pain, hypotension and a diffuse, maculopapular, erythematous rash. Laboratory tests showed eosinophilia alongside elevated levels of AST, ALT and lipase. Skin biopsy revealed mixed acute and chronic dermal inflammation. She was diagnosed with DRESS syndrome with acute pancreatitis and hepatitis due to lamotrigine. Lamotrigine was discontinued. IV fluids and empirical antibiotic therapy were initiated. Her symptoms and aberrant laboratory parameters subsequently resolved. A 58-year-old man with a history of gout received allopurinol [therapeutic indication, dosage and route not stated] starting 3 weeks prior to presentation. He presented with malaise, fever, abdominal pain and a diffuse, erythematous, pustular rash. Laboratory tests showed an elevated WBC count with eosinophilia alongside elevated levels of AST, ALT, bilirubin, amylase and lipase. Skin biopsy showed neutrophilic dermatitis with acute suppurative folliculitis. He was diagnosed with DRESS syndrome due to allopurinol. Allopurinol was discontinued. IV fluids and high-dose prednisone were initiated. His symptoms and laboratory parameters subsequently improved and he was discharged on a steroid taper regimen. Author comment: "We report two cases of DRESS syndrome with both hepatitis and pancreatitis." Vahora Z, et al. Pancreatitis and hepatitis as manifestations of dress syndrome: Two case reports. American Journal of Gastroenterology 107 (Suppl. 1): S327 803079911 abstr. 794, Oct 2012. - USA

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Reactions 24 Nov 2012 No. 1429