Hall David Jeffrey, Fromm Jason Steven
Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100277, Gainesville, FL, 32610-0277, USA.
J Med Case Rep. 2013 Jan 3;7:2. doi: 10.1186/1752-1947-7-2.
Drug reaction with eosinophilia and systemic symptoms syndrome is a potentially life-threatening hypersensitivity reaction with rash, fever, and internal organ involvement, often hepatitis, occurring most commonly two to eight weeks after initiation of a medication. The present case is an example of severe and potentially life-threatening hepatitis as a manifestation of drug reaction with eosinophilia and systemic symptoms syndrome.
We report a case of anti-epileptic-induced drug reaction with eosinophilia and systemic symptoms syndrome in an 18-year-old African-American man who presented with a five-day history of rash, periorbital and upper extremity edema, hepatitis and fever. Laboratory findings revealed an atypical lymphocytosis, eosinophilia, and elevated serum transaminases. No drug allergies were reported at the time of presentation, but phenytoin and levetiracetam therapy had been initiated five weeks prior to hospital admission for new-onset seizures. Both medications were discontinued on hospital admission, and after three days of high-dose corticosteroid therapy the patient experienced resolution of both his symptoms and laboratory markers of inflammation.
Given the significant mortality attributed to drug reaction with eosinophilia and systemic symptoms syndrome, medical personnel should be aware of the potential for this severe hypersensitivity reaction and should ensure close follow-up and offer anticipatory guidance when beginning any new medication, particularly anti-epileptic therapy. Early recognition of drug reaction with eosinophilia and systemic symptoms syndrome and initiation of appropriate therapy are imperative in limiting morbidity.
药物超敏反应伴嗜酸性粒细胞增多和全身症状综合征是一种潜在危及生命的超敏反应，伴有皮疹、发热和内脏器官受累，常见肝炎，通常在开始用药后两到八周出现。本病例是药物超敏反应伴嗜酸性粒细胞增多和全身症状综合征表现为严重且潜在危及生命的肝炎的一个例子。
我们报告一例18岁非裔美国男性因抗癫痫药物引发的药物超敏反应伴嗜酸性粒细胞增多和全身症状综合征，患者有五天的皮疹、眶周和上肢水肿、肝炎及发热病史。实验室检查发现非典型淋巴细胞增多、嗜酸性粒细胞增多及血清转氨酶升高。就诊时未报告药物过敏史，但在入院前五周因新发癫痫开始使用苯妥英钠和左乙拉西坦治疗。入院后停用两种药物，经过三天高剂量皮质类固醇治疗，患者症状及炎症实验室指标均得到缓解。
鉴于药物超敏反应伴嗜酸性粒细胞增多和全身症状综合征有较高死亡率，医务人员应意识到这种严重超敏反应的可能性，在开始任何新药特别是抗癫痫治疗时应确保密切随访并提供预防性指导。早期识别药物超敏反应伴嗜酸性粒细胞增多和全身症状综合征并开始适当治疗对于降低发病率至关重要。
