Phenobarbital
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DRESS syndrome in an elderly patient: case report A 74-year-old man developed DRESS syndrome while receiving phenobarbital. The man was admitted with a high fever, diarrhoea, a widespread maculopapular rash, pruritic lesions, lower limb oedema and confusion. One month earlier, he had developed an alcohol withdrawal syndrome with generalised seizure, and started phenobarbital [dosage and route not stated]. On admission, an x-ray revealed pneumonitis. The man received antibacterials; however, his symptoms persisted. Subsequently, a CT scan with steroidal premedication revealed resolution of his pneumonitis. He received alternative antibacterial therapy, and his clinical picture improved significantly. Subsequently, he developed a new-onset high fever and diarrhoea. Tests were positive for Clostridium difficile, and he received vancomycin. His diarrhoea resolved, but his maculopapular erythema and fever worsened, while tests revealed elevated serum creatinine and eosinophilia. Seven days later, he developed severe global erythroderma, inguinal lymphadenopathy and lower limb oedema. An ADR was suspected. Phenobarbital was withdrawn, and he received corticosteroids. Subsequently, his fever resolved, while his erythroderma and oedema improved. Author comment: "The Naranjo adverse drug reaction scale indicated a probable correlation (score 7 of 10) between the development of DRESS syndrome and phenobarbital." Gabbani T, et al. The usual suspects. Italian Journal of Medicine 6 (Suppl. 1): 62-63, No. 1, May 2012. Available from: URL: http://dx.doi.org/10.1016/ 803074420 j.itjm.2012.04.004 [abstract] - Italy
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Reactions 28 Jul 2012 No. 1412
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