LAMOTRIGIN-INDUCED DRESS SYNDROME: AN IDIOSYNCRATIC REACTION

• DOI: 10.22533/at.ed.1593482330067

• Palavras-chave: lamotrigine, DRESS, acute liver failure.

• Keywords: lamotrigine, DRESS, acute liver failure.

• Abstract:

  Objective: This report demonstrates an unexpected, rare and severe reaction to drugs, which may evolve with severe organic dysfunction, mainly liver.
  Introduction: Drug reaction syndrome with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic, potentially fatal form of drug-induced, T-cell-mediated hypersensitivity. It predominates in women and includes fever, rash, hematologic changes, lymph node enlargement, and organ involvement. The most related drugs are aromatic anticonvulsants and allopurinol. The trigger is herpes virus infection, in addition to association with HLA polymorphisms and enzymatic alterations of cytochrome P450, favoring the accumulation of toxic metabolites. The symptoms appear, on average, 3 weeks after the introduction of the drug, and may persist or even worsen after the drug is discontinued. The evolution to organic dysfunction is critical, with acute liver failure being infrequent, but predictive of mortality.
  Case report: Young female patient admitted for acute febrile icteric syndrome and history of previous pharyngotonsillitis. Started Lamotrigine 1 month ago. Upon admission, all drugs for continuous use were suspended. Within 3 days, a generalized rash, abdominal pain, persistent fever and hyperlactatemia appeared. Serologies and rheumatological tests were negative. Laboratory tests and imaging showed acute hepatitis. Evaluated by Gastroenterology and Infectology who suspected Epstein-Barr infection, dengue fever or drug-induced hepatitis. She had progressive organ dysfunction, associated with eosinophilia and the presence of atypical lymphocytes, suggesting DRESS. She evolved with liver failure, being referred to the transplant center, where she manifested encephalopathy, proceeding with the transplant. The patient reacted acutely to the graft,
  Conclusion: DRESS syndrome is a severe drug reaction involving viral, genetic, enzymatic and autoimmune mechanisms. Early diagnosis, discontinuation of drugs and corticosteroid therapy are essential to improve outcomes.