Gupta Tarana
Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Euroasian J Hepatogastroenterol. 2019 Jul-Dec;9(2):102-103. doi: 10.5005/jp-journals-10018-1298.
Drug rash eosinophilia with systemic symptoms (DRESS syndrome) presents as an acute febrile illness with leukocytosis, eosinophilia, lymphadenopathy, skin rash with acute hepatitis, renal failure, myositis, or systemic organ involvement. Aromatic anticonvulsants like phenytoin, carbamazepine, and phenobarbital cause drug-induced hypersensitivity or DRESS syndrome. However, sodium valproate being nonaromatic compound although known hepatotoxic drug in preexisting chronic liver disease has never been reported to cause DRESS syndrome alone. Here we report an interesting case of DRESS syndrome caused by valproate, which presented as an acute hepatitis illness with rash, renal dysfunction, and typical hematological features of DRESS syndrome within 2 months of the introduction of the drug in an epileptic patient. Patient initially showed a good response to intravenous steroids with improvement in the liver and renal dysfunction. However, later on, developed pancytopenia either due to steroid-induced sepsis or DRESS syndrome-related secondary hemophagocytosis (HPS) due to involvement of bone marrow as a rare occurrence and succumbed to illness.
Gupta T. Valproate-induced Drug Rash Eosinophilia with Systemic Symptoms Syndrome: An Unknown Hepatotoxicity. Euroasian J Hepato-Gastroenterol 2019;9(2):102-103.
药物疹伴嗜酸性粒细胞增多和全身症状（DRESS综合征）表现为急性发热性疾病，伴有白细胞增多、嗜酸性粒细胞增多、淋巴结病、皮疹，可伴有急性肝炎、肾衰竭、肌炎或全身器官受累。苯妥英钠、卡马西平和苯巴比妥等芳香族抗惊厥药可引起药物性超敏反应或DRESS综合征。然而，丙戊酸钠作为非芳香族化合物，虽然在已有慢性肝病中是已知的肝毒性药物，但从未有单独引起DRESS综合征的报道。在此，我们报告一例由丙戊酸钠引起的DRESS综合征的有趣病例，该病例在一名癫痫患者使用该药物2个月内表现为急性肝炎，伴有皮疹、肾功能不全以及DRESS综合征典型的血液学特征。患者最初对静脉注射类固醇反应良好，肝肾功能有所改善。然而，后来出现全血细胞减少，原因可能是类固醇诱导的败血症，也可能是由于骨髓受累导致的DRESS综合征相关的继发性噬血细胞综合征（HPS），这是一种罕见情况，最终患者因病死亡。
Gupta T.丙戊酸钠诱导的药物疹伴嗜酸性粒细胞增多和全身症状综合征：一种未知的肝毒性。《欧亚肝脏胃肠病学杂志》2019年；9(2):102 - 103。
