Page 34 - Livre électronique des RFTP 2023

P10. CARBAMAZEPINE-INDUCED DRUG REACTION WITH
EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS)

SYNDROME: THE VALUE OF PATCH TESTING IN DIAGNOSIS
- A CASE SERIES

R. SLIM1, F. CHAHED1, N. FATHALLAH1, N. AMORRI 1, S. MOKNI 2, N. FETOUI GHARIANI
2, M. DENGUEZLI2, C. BEN SALEM1, B. OUNI1

1. DEPARTMENT OF PHARMACOVIGILANCE, METABOLICBIOPHYSICS AND
APPLIEDPHARMACOLOGYLABORATORY (LR12ES02), FACULTY OF MEDICINE OF SOUSSE,
UNIVERSITY OF SOUSSE, TUNISIA
2. DEPARTMENT OF DERMATOLOGY, FARHAT HACHEDUNIVERSITY HOSPITAL, SOUSSE, TUNISIA

INTRODUCTION : DRESS syndrome is a potentially life-threatening
hypersensitivity reaction commonly associated with the use of antiepileptic drugs
especially carbamazepine, an aromatic anticonvulsant.

OBJECTIVE : We present a case series of patients who developed DRESS
syndrome after exposure to carbamazepine and emphasize the usefulness of the
patch test (PT) in confirming the diagnosis.

METHOD : We included all cases of DRESS related to carbamazepine notified to
the pharmacovigilance department of the University Hospital of Sousse-Tunisia
over a period of 6 years (2017-2022).

RESULTS : 13 patients (8F /5M) were included in this study. The median age was
50 years [15-74 years]. The median time interval between the onset of symptoms
and the onset of DRESS was 54 days [11-180 days]. Underlying atopy was presented
in one patient. All patients presented with diffuse maculopapular exanthema and
pruritus. Pustular eruptions were observed in three patients. Mucosal involvement
was noted in 2 patients. Fever and lymphadenopathy were noted in 7 and 4 patients
respectively. Eosinophilia was identified in 10 patients. Hepatic involvement with
cytolysis was present in 10 patients and associated with cholestasis in 7 patients.
Two patients had acute renal failure. Rhabdomyolysis was noted in 5 patients.
Dyspnea was found in 3 patients. A high level of serum lipase was identified in one
patient. To manage the condition, carbamazepine was immediately withdrawn in
all patients. Treatment with prednisone and antihistaminic therapy was
administered in 9 patients. Blood cell counts, renal functions, blood pressures,
heart rates, body temperatures, and oxygen saturation throughout the course of
treatment were monitored in all patients. Skin biopsies were performed in 7
patients and were consistent with DRESS syndrome. The clinical and biological
course was favorable in all patients. The imputability of carbamazepine was
probable in all cases. PTs were performed on 10 patients and were positive at the
72 reading, in 9 patients. To investigate the cross-reactivity between the aromatic
anticonvulsants (Phenytoin, phenobarbital, Lamotrigine), PTs were carried out and
revealed negative in 100% of cases. After a period of 3 years, a patient experienced

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