Fong Man Kei, Sheng Bun
Department of Medicine and Geriatrics Princess Margaret Hospital Kowloon Hong Kong.
Epilepsia Open. 2017 Apr 28;2(2):273-275. doi: 10.1002/epi4.12053. eCollection 2017 Jun.
A 42-year-old patient with epilepsy was admitted to the hospital for fever and generalized skin rash. He has known allergy to phenytoin. Valproate was started in 2012, but failed to control his seizure despite gradual increase in dosage. Phenobarbitone was added 16 days before admission and was stopped on admission. He was treated with beta-lactam antibiotics. The rash subsided gradually after the cessation of phenobarbitone. Lacosamide was subsequently added for seizure control. Unfortunately, he developed drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome soon after introduction of lacosamide that required the use of systemic steroid for acute hepatitis. A cross-reactivity with lacosamide was suspected in view of the rapid onset of DRESS syndrome after the initial rash resolution and soon after the introduction of lacosamide. We postulated that the rapid onset of DRESS syndrome may be related to the aromatic ring that is in common among phenytoin, phenobarbitone, and lacosamide.
一名42岁的癫痫患者因发热和全身性皮疹入院。他已知对苯妥英过敏。丙戊酸盐于2012年开始使用，但尽管剂量逐渐增加，仍未能控制其癫痫发作。入院前16天加用苯巴比妥，并在入院时停用。他接受了β-内酰胺类抗生素治疗。停用苯巴比妥后皮疹逐渐消退。随后加用拉科酰胺以控制癫痫发作。不幸的是，在引入拉科酰胺后不久，他就出现了伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）综合征，需要使用全身性类固醇治疗急性肝炎。鉴于在最初皮疹消退后以及引入拉科酰胺后不久迅速出现DRESS综合征，怀疑与拉科酰胺存在交叉反应。我们推测DRESS综合征的迅速发作可能与苯妥英、苯巴比妥和拉科酰胺共有的芳香环有关。
