Khan Zahid, Warrier Vinod, Muhammad Syed Aun, Gupta Animesh, Yousif Yousif, Khan Ayub, Afghan Abdullah, Taucius Donatas, Abumedian Mohammed, Ibrahim Maab, Mohammed Mohammed, Mlawa Gideon
Cardiology, Royal Free Hospital NHS Foundation Trust, London, GBR.
Internal Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR.
Cureus. 2022 Feb 18;14(2):e22359. doi: 10.7759/cureus.22359. eCollection 2022 Feb.
A 29-year-old patient presented to the hospital with worsening generalized rash for the last two days from a mental health facility. The patient was commenced on lamotrigine two weeks earlier, and he developed fever and generalized macular rash on his body. His blood tests showed deranged liver function tests (LFTs) and clotting with raised eosinophil count, and he was treated for lamotrigine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. The patient was commenced on prednisolone 50 mg once daily with a proton pump inhibitor cover, and lamotrigine was suspended on advice from Dermatology. The patient showed improvement after 3-4 days of treatment. His skin biopsy showed prominent suppurative granulomatous folliculitis, mild perivascular chronic inflammation, and red blood cell extravasation, including the rare eosinophil. He was weaned off from prednisolone by 5 mg weekly and had complete resolution of symptoms.
一名29岁的患者从一家精神卫生机构转至我院,因其在过去两天内全身皮疹情况恶化。该患者两周前开始服用拉莫三嗪,之后出现发热及全身斑疹。其血液检查显示肝功能检查结果异常、凝血功能异常且嗜酸性粒细胞计数升高,他因拉莫三嗪诱发的伴有嗜酸性粒细胞增多和全身症状的药物反应(DRESS)综合征接受治疗。患者开始每日服用一次50毫克泼尼松龙,并加用质子泵抑制剂,同时根据皮肤科建议停用拉莫三嗪。治疗3 - 4天后患者情况有所改善。其皮肤活检显示有明显的化脓性肉芽肿性毛囊炎、轻度血管周围慢性炎症以及红细胞外渗,包括罕见的嗜酸性粒细胞。他每周以5毫克的剂量逐渐减少泼尼松龙用量,症状完全消退。