Karuppannasamy Divya, Andavar Raghuram, Arumugam Jayavardhana, Muthuvel Kumaresan
Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
Department of Paediatrics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
J Ophthalmic Vis Res. 2019 Jul 18;14(3):382-386. doi: 10.18502/jovr.v14i3.4795. eCollection 2019 Jul-Sep.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, life-threatening multi-system adverse drug reaction characterized by febrile skin rash, hematologic abnormalities, and involvement of internal organs. We report a case of DRESS syndrome in a child presenting with primary ophthalmic manifestations.
An 11-year-old boy presented with severe pain and diminished vision in both eyes six weeks after starting carbamazepine therapy for seizure disorder. Ocular examination revealed features of bilateral acute anterior uveitis, acute onset myopia, and angle closure glaucoma secondary to uveal effusion. Additionally, the patient was febrile with a generalized maculopapular rash, and blood investigations revealed eosinophilic leukocytosis. A diagnosis of carbamazepine-induced DRESS syndrome was made, and carbamazepine therapy was discontinued. Treatment with cycloplegics, topical, and systemic steroids resulted in prompt clinical recovery.
Ophthalmologists should be aware that hypersensitivity to anticonvulsants, such as carbamazepine, can present with bilateral uveitis and uveal effusion along with systemic symptoms. Prompt diagnosis and treatment can prevent vision loss and life-threatening complications. Patients should be counselled about potential adverse effects of anticonvulsants before therapy.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征是一种罕见的、危及生命的多系统药物不良反应，其特征为发热性皮疹、血液学异常以及内脏器官受累。我们报告一例以原发性眼部表现为特征的儿童DRESS综合征病例。
一名11岁男孩在开始使用卡马西平治疗癫痫症六周后出现双眼剧痛和视力下降。眼部检查发现双侧急性前葡萄膜炎、急性发作性近视以及葡萄膜渗漏继发的闭角型青光眼的特征。此外，患者发热，伴有全身性斑丘疹，血液检查显示嗜酸性粒细胞增多。诊断为卡马西平诱发的DRESS综合征，并停用卡马西平治疗。使用睫状肌麻痹剂、局部和全身类固醇治疗后，临床症状迅速恢复。
眼科医生应意识到，对抗惊厥药物如卡马西平的超敏反应可能表现为双侧葡萄膜炎和葡萄膜渗漏以及全身症状。及时诊断和治疗可预防视力丧失和危及生命的并发症。在治疗前，应向患者告知抗惊厥药物的潜在不良反应。
