EBV Reactivation in A Case of DRESS Syndrome Associated with Lamotrigine: A Case Report

Mahmoud   Ahmed   Kiblawi; Mohamad      El Saleh; Ashraf      El Ghul

doi:10.2174/03666211230091347

Abstract

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is a rare, T-cell mediated hypersensitivity reaction that develops secondary to a drug reaction. Several drugs have been associated with DRESS syndrome, most commonly carbamazepine. The mechanism is not clearly understood. It is a life-threatening condition that can present with skin rash, hematologic abnormalities, lymphadenopathy, and organ failure.

Case Presentation: The authors report a case of 43-year-old gentleman who developed DRESS syndrome secondary to lamotrigine and was found to have EBV reactivation. Patient was managed with supportive care; topical steroids and the culprit drug were discontinued. He had full recovery almost 2 weeks following treatment. DRESS syndrome can occur 2 weeks following exposure to an offending drug in susceptible individuals.

Conclusion: Lamotrigine and EBV reactivation are not frequently reported in patients with DRESS syndrome. Therefore, physicians should be vigilant about this rare drug related hypersensitivity reaction in order to prevent life threatening complications.

Keywords: DRESS Syndrome, Lamotrigine, EBV reactivation, drug reaction, hypersensitivity reaction, rash

[1]
Bocquet H, Bagot M, Roujeau JC. Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Semin Cutan Med Surg  1996; 15(4): 250-7.
 [http://dx.doi.org/10.1016/S1085-5629(96)80038-1] [PMID: 9069593]

[2]
Muller P, Dubreil P, Mahé A, et al. Drug hypersensitivity syndrome in a West-Indian population. Eur J Dermatol  2003; 13(5): 478-81.
 [PMID: 14693494]

[3]
Cacoub P, Musette P, Descamps V, et al. The DRESS syndrome: a literature review. Am J Med  2011; 124(7): 588-97. Available from: 
                    https://www.amjmed.com/article/S0002-9343(11)00258-0/fulltext
 [http://dx.doi.org/10.1016/j.amjmed.2011.01.017] [PMID: 21592453]

[4]
Descamps V, Valance A, Edlinger C, et al. Association of human herpesvirus 6 infection with drug reaction with eosinophilia and systemic symptoms. Arch Dermatol  2001; 137(3): 301-4.
 [PMID: 11255328]

[5]
Chen YC, Chiu HC, Chu CY. Drug reaction with eosinophilia and systemic symptoms: a retrospective study of 60 cases. Arch Dermatol  2010; 146(12): 1373-9. Available from: 
                    https://jamanetwork.com/journals/jamadermatology/fullarticle/422535
 [http://dx.doi.org/10.1001/archdermatol.2010.198] [PMID: 20713773]

[6]
Takahashi R, Kano Y, Yamazaki Y, Kimishima M, Mizukawa Y, Shiohara T. Defective regulatory T cells in patients with severe drug eruptions: timing of the dysfunction is associated with the pathological phenotype and outcome. J Immunol  2009; 182(12): 8071-9. Available from: 
                    https://www.jimmunol.org/content/182/12/8071
 [http://dx.doi.org/10.4049/jimmunol.0804002] [PMID: 19494333]

[7]
Niu J, Jia Q, Ni Q, et al. Association of CD8(+) T lymphocyte repertoire spreading with the severity of DRESS syndrome. Sci Rep  2015; 5: 9913.
 [http://dx.doi.org/10.1038/srep09913] [PMID: 25905582]

[8]
Kano Y, Inaoka M, Shiohara T. Association between anticonvulsant hypersensitivity syndrome and human herpesvirus 6 reactivation and hypogammaglobulinemia. Arch Dermatol  2004; 140(2): 183-8. Available from: 
                    https://jamanetwork.com/journals/jamadermatology/fullarticle/480290
 [http://dx.doi.org/10.1001/archderm.140.2.183] [PMID: 14967790]

[9]
Cho YT, Yang CW, Chen YC, Chu CY. Comment on “Viral reactivation in hospitalized DRESS patients: A retrospective study from a tertiary medical center in the United States”. J Am Acad Dermatol  2020; 83(3): e209-10. Available from: 
                    https://www.jaad.org/article/S0190-9622(20)30853-7/fulltext
 [http://dx.doi.org/10.1016/j.jaad.2020.04.175] [PMID: 32413450]

[10]
Choudhary S, McLeod M, Torchia D, Romanelli P. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. J Clin Aesthet Dermatol  2013; 6(6): 31-7.
 [PMID: 23882307]

[11]
Wu X, Yang F, Chen S, et al. Clinical, viral and genetic characteristics of drug reaction with eosinophilia and systemic symptoms (DRESS) in shanghai, China. Acta Derm Venereol  2018; 98(4): 401-5. Available from: 
                    https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-2867
 [http://dx.doi.org/10.2340/00015555-2867] [PMID: 29242946]

[12]
Ksouda K, Affes H, Mahfoudh N, et al. HLA-A*31:01 and carbamazepine-induced DRESS syndrom in a sample of North African population. Seizure  2017; 53: 42-6. Available from: 
                    https://www.seizure-journal.com/article/S1059-1311(17)30448-X/fulltext
 [http://dx.doi.org/10.1016/j.seizure.2017.10.018] [PMID: 29125944]

[13]
Chen YC, Chang CY, Cho YT, Chiu HC, Chu CY. Long-term sequelae of drug reaction with eosinophilia and systemic symptoms: a retrospective cohort study from Taiwan. J Am Acad Dermatol  2013; 68(3): 459-65.
 [http://dx.doi.org/10.1016/j.jaad.2012.08.009] [PMID: 22959230]

[14]
Pannu AK, Saroch A. Diagnostic criteria for drug rash and eosinophilia with systemic symptoms. J Family Med Prim Care  2017; 6(3): 693-4.
 [http://dx.doi.org/10.4103/2249-4863.222050] [PMID: 29417040]

[15]
Funck-Brentano E, Duong TA, Bouvresse S, et al. Therapeutic management of DRESS: a retrospective study of 38 cases. J Am Acad Dermatol  2015; 72(2): 246-52.
 [http://dx.doi.org/10.1016/j.jaad.2014.10.032] [PMID: 25592341]