Antiepileptic Drug-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Case Series

TL;DR

This study presents seven cases of a severe drug reaction caused by antiepileptic drugs, highlighting the importance of early detection and monitoring.

Contribution

The paper contributes a case series analyzing antiepileptic drug-induced DRESS syndrome with detailed pharmacovigilance assessments.

Findings

Phenytoin was the most common cause of DRESS in the cases studied.

All cases showed definite DRESS with eosinophilia and hepatotoxicity.

Corticosteroid treatment led to recovery within 10 to 35 days.

Abstract

Introduction/Background: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe cutaneous adverse drug reaction with multisystem involvement frequently triggered by aromatic antiepileptic drugs (AED) like phenytoin, carbamazepine, etc. The pathogenesis is due to reactive metabolites and the immune reaction of delayed-type hypersensitivity. This case series addresses the key clinical presentation with pharmacological and pharmacovigilance aspects of the DRESS syndrome.

Methodology: This case series describes seven cases of AED-induced DRESS syndrome, assessed with Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) criteria from a tertiary care teaching hospital in Tamil Nadu. Clinical presentation, laboratory parameters, causality assessment (WHO-UMC, Naranjo, Liverpool), preventability assessment (Modified Schumock Thornton), and severity grading (Hartwig-Siegel scale) were recorded. All assessment tools used are open access and properly cited.

Results: Phenytoin was the most common causative agent, followed by oxcarbazepine, valproate, and levetiracetam. Clinical presentation varied from five to 28 days of drug exposure. All cases were diagnosed to have definite DRESS. The majority of patients exhibited eosinophilia and systemic involvement in the form of hepatotoxicity. Corticosteroid therapy led to clinical resolution with hospital stays ranging from 10 to 35 days.

Conclusions: AED-induced DRESS poses a significant pharmacological challenge due to its unpredictable immunopathogenesis and genetic predisposition. Pharmacovigilance strategies and early clinical recognition by recognizing subtle laboratory parameters are essential to mitigate potential risks. Future research should focus on identifying biomarkers, optimizing drug selection, and implementing structured monitoring in high-risk populations.

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