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Drug Hypersensitivity to Previously Tolerated Phenytoin

Source: jkms.kams.or.kr
Topic: Drugs
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Sort Desciption: Hypersensitivity syndrome is an idiosyncratic, serious drug reaction that consists of a rash, fever, involvement of multiple visceral organs, and hematological abnormalities such as eosinophilia. ...

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Hypersensitivity syndrome is an idiosyncratic, serious drug reaction that consists of a rash, fever, involvement of multiple visceral organs, and hematological abnormalities such as eosinophilia. To better individualize drug hypersensitivity reaction and to distinguish the hypersensitivity reaction from drug-induced pseudolymphoma, Bocquet et al. have recently introduced the term drug rash with eosinophilia and systemic symptoms (DRESS) syndrome (1). Anticonvulsants are the principal drugs responsible for this malady. Among them, arene oxide producing aromatic anticonvulsants such as pheny- toin and carbamazepine are the particular drugs most frequently implicated for DRESS syndrome or the anticonvulsant hypersensitivity syndrome (AHS) (2-10). Cross-reactivity among the aromatic anticonvulsants frequently occurs when a previous history of DRESS syndrome exists (10-12). Many studies have described cross sensitivity as a worsening of the initial features of DRESS syndrome when switching from a sensitive anticonvulsant to a cross-reactive anticonvulsant (8, 13-15). However limited data have described the development of DRESS syndrome after switching medication from a previously well-tolerated anticonvulsant to another (5-7). We present here a case of DRESS syndrome in which hyper- sensitivity reaction to a previously well-tolerated phenytoin was induced by hypersensitivity to carbamazepine, and we show that the patch test may be a useful method for detecting possible cross-reactive drugs in such situations. CASE REPORT A 40-yr-old man suffering from epilepsia presented with a generalized skin rash, facial edema, sore throat and high- grade fever of 3-day duration. He had been taken phenytoin and sodium valproate for 4 yr without having any adverse reaction. Because of several attacks of seizure while taking these anticonvulsants, the medications ...

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