Drug reaction with eosinophilia and systemic symptoms in a child on multiple antiepileptics

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is anadverse drug-reaction that may mimic systemic illnesses and have a fulminantpresentation. We describe an 8-year-old girl with epilepsy and exposure tomultiple anti-epileptics who presented with fever, extensive maculopapular rash,cervical lymphadenopathy, hepatomegaly, progressive anemia and transaminitis.Infections, autoimmune disorders and hematological or reticuloendothelialmalignancies were excluded. Based on the proposed diagnostic criteria, adiagnosis of DRESS was concluded. Her skin biopsy showed atypical findingsconsistent with erythema multiforme. Suspected anti-epileptic drugs werediscontinued. She was administered pulse methyl-prednisolone therapy andbroad-spectrum antibiotics along with adequate supportive management.Unfortunately, the child succumbed to nosocomial sepsis. Our case highlightsthe importance of early suspicion for diagnosis of pediatric DRESS, avoidanceof polytherapy and institution of early immunomodulation to improve theoutcomes in children in this condition.