Phenobarbital
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DRESS syndrome with sepsis, ARDS and pneumomediastinum in a child: case report A 10-year-old girl developed DRESS syndrome with Acinetobacter sepsis, acute respiratory distress syndrome (ARDS) and pneumomediastinum during treatment with phenobarbital for seizures; she subsequently died. The girl presented with a 20-day history of intermittent fever with cough and a 15-day history of generalised rash. She had been receiving oral phenobarbital for 6 weeks [dosage not stated]. She was febrile, icteric and toxic when hospitalised, with enlarged lymph nodes, tachypnoea, tachycardia, conjunctival congestion and stomatitis. She had a diffuse erythematous maculopapular rash, tender hepatomegaly, and diffuse crepitations over both sides of her chest. Investigations revealed elevated levels of bilirubin, liver enzymes and eosinophils, and leukocytosis, pyuria and microscopic haematuria. Imaging demonstrated pericardial effusion, hepatomegaly with features of hepatitis, and features of diffuse pneumonitis. The girl received empirical antibiotics, which were altered when her fever and dyspnoea persisted; dexamethasone was added. Her condition improved, but a few days later she reported respiratory distress exacerbation. She had developed pneumomediastinum and subcutaneous emphysema, with intermittent fever. Blood culture revealed A. baumanii, and her antibiotic treatment was changed. Her condition deteriorated, and she developed ARDS. She improved with ventilation, and was extubated 6 days later. However, fever and dyspnoea recurred after 2 days. Chest X-ray revealed ARDS and pneumothorax. Ventilation was restarted, but she died 5 days later. Giri PP, et al. Dress syndrome with sepsis, acute respiratory distress syndrome and pneumomediastinum. Indian Journal of Dermatology 56: 763-765, No. 6, Nov-Dec 2011. Available from: URL: http://dx.doi.org/10.4103/0019-5154.91850 803068670 India
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Reactions 7 Apr 2012 No. 1396
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