Zonisamide
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DRESS syndrome: case report A 29-year-old man developed DRESS syndrome during treatment with zonisamide. The man was hospitalised with acute kidney injury and a diffuse skin eruption with oedema of his face. He had started zonisamide 300mg [frequency not stated] 2 months earlier for temporal epilepsy. He noticed the eruption 12 days before admission, and had lumbago, sore throat and low-grade fever 7 days before admission. He was prescribed cefcapene pivoxil, paracetamol [acetaminophen], tranexamic acid and lansoprazole; additionally, he discontinued zonisamide on the same day by his own judgement. Four days prior to admission his temperature increased to 38.9°C. Laboratory tests revealed the following: AST 65 IU/L, ALT 132 IU/L and GGT 153 IU/L. His urinary volume decreased 2 days later; he had loss of appetite and aggravated skin rash. On admission, consciousness was drowsy, temperature 38°C, BP 130/81mm Hg, pulse 57 beats/minute and increased bodyweight (71kg). Facial oedema and a generalised pruritic maculopapular rash with lichen were present. He had painful cervical, axillary and inguinal lymphadenopathy, pain on both costovertebral angle regions, eosinophilia, hypogammaglobulinaemia and kidney and liver dysfunction. Splenomegaly and bilateral hydronephrosis were shown on abdominal ultrasonography. His creatinine level was 8.20 mg/dL 8 hours after admission. The man received furosemide; however, anuria persisted. Fever continued despite haemodialysis, and, on hospital day 4, his eruption evolved to flaccid vesicles and bullae. Prednisolone was started and the eruption improved. Urinary volume increased and his bodyweight decreased. Haemodialysis was discontinued on day 5 and prednisolone dosage was reduced on day 8. He developed a high fever on day 10 and atypical cells were present in the blood during days 13–15, but thereafter improved. Human herpesvirus 6 (HHV-6) DNA was no longer detectable in the blood on day 20; anti-HHV-6 IgG levels increased. A skin patch test revealed zonisamide hypersensitivity. Fujita Y, et al. Acute kidney injury caused by zonisamide-induced hypersensitivity syndrome. Internal Medicine 49: 409-413, No. 5, Jan 2010. Available from: URL: 803014083 http://dx.doi.org/10.2169/internalmedicine.49.2451 - Japan
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Reactions 15 May 2010 No. 1301
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