Pregabalin
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DRESS syndrome and hypereosinophilic syndrome: case report A 56-year-old man developed DRESS syndrome and hypereosinophilic syndrome during treatment with pregabalin. The man, who had trigeminal neuralgia, epilepsy, chronic pain syndrome, coeliac disease, fibromyalgia and hypertension, presented (in June 2017) with malaise, fever, breathlessness and raised eosinophils. Eight weeks prior to the presentation, he had been receiving treatment with pregabalin [route and dosage not stated]. Laboratory tests showed above normal levels of WBC, neutrophils, eosinophils, CRP, and below normal level of haemoglobin. Total immunoglobulin (Ig)E was elevated. A chest radiograph demonstrated bilateral consolidation. A CTscan demonstrated extensive bilateral confluent ground-glass opacities. Based on the examinations and the presenting symptoms, community-acquired pneumonia was suspected. Consequently, the man’s treatment was started with various antibiotics, but his clinical condition continued to deteriorate requiring ICU admission. Non-invasive ventilation was also started due to worsening respiratory failure and oxygen requirements. A biopsy was scheduled, but the rash resolved with steroid prior to the biopsy. Eventually, based on RegiSCAR scoring system, he was diagnosed with DRESS syndrome. His treatment was started with methylprednisolone, which was continued for 6-days, This was followed by prednisolone. His life-threatening respiratory failure progressed by day 14 with evidently rising transaminases, persistent hypereosinophilia and elevated serum interleukin-5 (IL) despite treatment with methylprednisolone and prednisolone. He developed acute pneumonitis secondary to DRESS. Later, after receiving approval from the local medicines management group, offlabel treatment with mepolizumab was started as a trial. Serum IL level dropped 24-hours after receiving mepolizumab. Eosinophilia and oxygenation improved over the next 13-days. Chest radiograph on 16-July-2017 (prior to discharge from intensive care) revealed persistent fibrotic changes. He was discharged from intensive care. His eosinophil count persistently remained
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