Anticonvulsant-induced Drug Rash with Eosinophilia and Systemic Symptoms and a severe leukamoid reaction in a Kenyan patient: Case report and review of the literature

Abstract

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) is rarely described in Kenya, despite being a life threatening and potentially fatal reaction to carbamazepine and other anticonvulsants. DRESS associated with severe leukamoid reaction is an even rarer entity that may be mistaken for sepsis or haematological disorders. Diagnostic delay and lack of prompt withdrawal of the offending drug and timely treatment may result in morbidity and mortality. The clinical presentation of DRESS may be misinterpreted because of a broad spectrum of clinical manifestations, delayed reactions and prolonged course. We present the case of a 27 year old female who presented with fever, joint pains, severe exfoliative rash all over the body, facial edema, mucosal ulceration and hepatitis 5 weeks after initiation of carbamazepine for mood disorder. Her complete blood count revealed severe leukocytosis with eosinophilia, while liver function test showed severe transaminitis. Although initially treated for sepsis based on the leukocytosis, a diagnosis of anticonvulsant hypersensitivity syndrome with DRESS and leukamoid reaction was made. She progressively improved after withdrawal of carbamazepine and initiation of steroids. We recommend that DRESS and leukamoid reaction in patients initiated on anticonvulsants within the last 2 months be considered and promptly treated. This case also highlights the importance of risk factor assessment in patients presenting with rashes, including proper drug history.