Lamotrigine
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DRESS syndrome: case report A 39-year-old man developed DRESS syndrome during treatment with lamotrigine [indication not stated]. The man presented to the emergency department with fever, sore throat, fatigue and rash. His presentation was deemed probable Epstein-Barr virus (EBV) and he was discharged. Five days later, he again presented to the emergency department. Physical examination showed a widespread polymorphic rash. His body temperature was 39.7°C and he had facial oedema. No mucosal involvement or lymphadenopathy was observed. Investigations revealed the following: moderate thrombocytopenia, acute kidney injury and deranged liver function. Peripheral blood smear showed atypical lymphocytes, mild lymphocytosis and vacuolated neutrophils, but there was no eosinophilia. Serology for hepatitis B and C, and EBV, as well as thyroid function, lipase and blood culture, were unremarkable. Skin histopathology revealed mixed spongiotic and lichenoid inflammatory infiltrate with marked dermal oedema; eosinophils were noted in small numbers. Kidney histopathology showed acute granulomatous tubulointerstitial nephritis. On further questioning it was found that he had started receiving lamotrigine 100 mg/day [route not stated] 4 weeks prior to the initial presentation. Seven days after the initial presentation, he was diagnosed with DRESS syndrome based on the RegiSCAR criteria [time to reaction onset not stated]. The man received treatment with methylprednisolone and lamotrigine was stopped. After 3 days, he became anuric with worsening renal function requiring haemodialysis. Immune-globulin [immunoglobulin] for 2 days was introduced due to a rapid deterioration of renal function, despite treatment with methylprednisolone. After 10 days, his renal and liver function recovered. He was later discharged with prednisolone which was scheduled to be tapered over 6 weeks. Kerkemeyer KLS, et al. Drug rash with eosinophilia and systemic symptoms syndrome without eosinophilia managed with intravenous immunoglobulin. Internal Medicine 803518025 Journal 50: 1156-1157, No. 9, Sep 2020. Available from: URL: http://doi.org/10.1111/imj.14997
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Reactions 28 Nov 2020 No. 1832
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