Drug reaction with eosinophilia and systemic symptoms for phenytoin

2016-06-23T09-23-22Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Sowmya Chinnaiyan, Bhuvana Krishnaswamy, Sarala Narayana, Rajashekar Talari Srinivas.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity syndrome characterized by fever, skin eruptions, hematologic abnormalities, and systemic involvement frequently reported with anticonvulsants, allopurinol, nevirapine, and sulfasalazine. We report a case of DRESS syndrome in a patient with neurocysticercosis receiving phenytoin. A 60-year-old male patient was diagnosed with seizures due to neurocysticercosis and was prescribed phenytoin. 2 weeks after therapy, the patient had fever, burning micturition, decreased appetite, and generalized weakness for which he was treated symptomatically by a local practitioner. 2 days later, fever had recurred with generalized cutaneous hyperemia which was treated with antimicrobials in a local hospital, as it did not resolve patient was referred to our hospital. The findings on examination were icterus, periorbital edema, oral mucositis, facial puffiness, and generalized maculopapular rashes. Eosinophils, erythrocyte sedimentation rate, and liver enzymes were elevated, abdominal scan revealed hepatomegaly and cystitis. It was diagnosed as DRESS and phenytoin were discontinued. He was treated with corticosteroids. There was a clinical improvement, and liver function test was normal after a month. DRESS is a Type IV delayed hypersensitivity reaction which manifests after 2-4 weeks of treatment with an offending agent. This report indicates that the occurrence of DRESS has a higher preponderance in patients receiving phenytoin for seizures due to neurocysticercosis.


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