Pediatric Allergy and Asthma Unit, Department of Paediatrics, School of Medicine, Hacettepe University, Ankara, Turkey.
Australas J Dermatol. 2012 Nov;53(4):274-7. doi: 10.1111/j.1440-0960.2012.00887.x. Epub 2012 Apr 24.
Drug reaction, eosinophilia and systemic symptoms (DRESS) is an acute and life-threatening disease, characterised by fever, rash and systemic symptoms, including lymphadenopathy, abnormal liver function, interstitial nephritis, pulmonary and cardiac infiltrates and haematological abnormalities with eosinophilia and atypical lymphocytes. The drugs mostly associated with DRESS are anticonvulsants, allopurinol, minocycline and sulfonamides. This syndrome is rarely seen in childhood even though a large number of children have anticonvulsant treatment. An 8-year-old girl was admitted with fever, lymphadenopathy and skin eruptions on her trunk. Her medical history was notable for epilepsy and carbamazepine treatment had been started 5 weeks previously. Laboratory studies showed a white cell count of 6200/µL (normal, 4100-11 200/µL) with 22% eosinophils and a γ-glutamyl transpeptidase level of 296 U/L (normal, 0-23 U/L). Laboratory tests for infections and collagen diseases were in the normal range. Persistence of fever and maculopapular eruption with generalised desquamation and the appearance of cheilitis and facial angioedema suggested a hypersensitivity reaction to carbamazepine. The carbamazepine was replaced with levetiracetam. All clinical symptoms improved within a week with corticosteroids and antihistamine treatment. Six weeks after complete recovery an epicutaneous patch test with carbamazepine was performed and a carbamazepine-induced positive skin reaction was observed at 48-h. Carbamazepine-induced DRESS syndrome is a rare entity in children. An epicutaneous patch test is a useful tool for identifying the inducing agent for the DRESS syndrome and for identifying a safe anticonvulsant drug.
药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种急性且危及生命的疾病，其特征为发热、皮疹和全身症状，包括淋巴结病、肝肾功能异常、间质性肾炎、肺部和心脏浸润以及伴有嗜酸性粒细胞和异型淋巴细胞的血液学异常。与 DRESS 相关的药物主要为抗惊厥药、别嘌醇、米诺环素和磺胺类药物。尽管大量儿童接受抗惊厥治疗，但儿童中很少见到这种综合征。一名 8 岁女孩因发热、淋巴结病和躯干皮肤疹入院。她的病史为癫痫，且 5 周前开始服用卡马西平。实验室研究显示白细胞计数为 6200/µL（正常范围为 4100-11200/µL），其中 22%为嗜酸性粒细胞，γ-谷氨酰转肽酶水平为 296 U/L（正常范围为 0-23 U/L）。感染和胶原疾病的实验室检查均在正常范围内。发热持续存在，伴有斑丘疹，全身脱皮，并出现唇炎和面部血管性水肿，提示对卡马西平产生超敏反应。卡马西平被换为左乙拉西坦。皮质类固醇和抗组胺治疗后，所有临床症状在一周内得到改善。完全恢复后 6 周，进行卡马西平斑贴试验，在 48 小时观察到卡马西平诱导的阳性皮肤反应。卡马西平诱导的 DRESS 综合征在儿童中较为罕见。斑贴试验是识别 DRESS 综合征诱导剂和识别安全抗惊厥药物的有用工具。
