Page 136 - Livre électronique des RFTP 2023

P88. PUSTULAR ERUPTION AS A KEY FEATURE OF
ANTICONVULSANT-INDUCED DRESS SYNDROME: A CASE

SERIES

F. CHAHED1, N. FATHALLAH1, O. BOURAOUI1, N. AMORRI1, S. MOKNI2, N. FETOUI
GHARIANI2, M. DENGUEZLI2, C. BEN SALEM1, R. SLIM1.

1. DEPARTMENT OF PHARMACOVIGILANCE, METABOLIC BIOPHYSICS AND APPLIED
PHARMACOLOGY LABORATORY (LR12ES02), FACULTY OF MEDICINE OF SOUSSE, UNIVERSITY OF
SOUSSE, TUNISIA
2. DEPARTMENT OF DERMATOLOGY, FARHAT HACHED UNIVERSITY HOSPITAL, SOUSSE, TUNISIA

INTRODUCTION : DRESS syndrome is a severe and potentially life-threatening
hypersensitivity reaction hat can occur in response to variousdrugs. It’susually
associated with macula papular eruptions and systemic involvement. Pustular
eruptions may appear in relatively few cases of DRESS syndrome

OBJECTIVE : We report three cases of a pustular variant of DRESS syndrome
induced by carbamazepine

METHOD : A retrospective study of cases of Pustular DRESS due to
Carbamazepine notified to the pharmacovigilance department of Sousse over a
period of 6 years (2017-2022)

CASE 1 : A 15-year-old with the depressive syndrome was treated with
carbamazepine and sertraline. After six weeks of treatment, shedeveloped a diffuse
maculopapular rash, facial edema, pustular eruption on the nose, cervical
lymphadenopathy, odynophagia, and fever. Laboratory tests revealed liver
involvement with cytolysis and hypereosinophilia. A skin biopsy specimen revealed
spongiotic dermatitis with eosinophils, superficial perivascular dermatitis, as well as
corneal, subcorneal, and intraepidermal neutrophilic micro abscesses, mimicking
acute generalizedexanthematouspustulosis. Even though clinical evaluation
suggested DRESS syndrome (RegiSCAR score=6).

CASE 2 : A 43-year-old patient with hypothyroidism was treated with levothyroxine
and carbamazepine for trigeminal neuralgia. Three weeks after carbamazepine
initiation, he developed a pruritic erythematous maculopapular rash that initially
appeared on the palms and soles but later spread to the face, scalp, and entire
body, associated with facial edema, pustular skin rash, and involvement of mucosal
membranes. Laboratory tests revealed hypereosinophilia with atypical
lymphocytes, liver dysfunction with cytolysis and rhabdomyolysis. Histological
assessment displayed subcornealspongiform pustules. The superficial dermitis
was e dermatous, with mixed inflammatory infiltration, including neutrophils and
eosinophils.

Case 3: A 53-year-old patient with recently diagnosed optic neuropathy was treated
with carbamazepine, baclofen, and pregabalin. Twenty-one days after starting the
treatment, the patient developed a facial edema generalized erythrodermic rash

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