DRESS syndrome: a case study of a drug-induced reaction under the guise of measles

DRESS syndrome: a case study of a drug-induced reaction under the guise of measles

T.M. Lebedeva¹, E.V. Melekhina^2, E.V. Guseva¹, E.R. Matveychuk³, A.D. Muzyka^2, A.A. Samkov³, D.S.Khanova³

¹Pirogov Russian National Research Medical University, Moscow

²Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

^3Infectious Diseases Clinical Hospital No. 1, Moscow

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, potentially life-threatening hypersensitivity reaction that is infrequently encountered in clinical pediatric practice. Its clinical presentation, often characterized by rash and fever, commonly mimics infectious diseases, delaying accurate diagnosis and appropriate management. Early recognition of DRESS syndrome, based on diagnostic criteria such as the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) or the Drug-Induced Hypersensitivity Syndrome (DiHS) criteria proposed by the Japanese consensus group, is essential for timely therapeutic intervention. Prompt diagnosis can prevent serious complications and reduce the risk of mortality. The aim of this study was to report a case of DRESS/DiHS in a pediatric patient, triggered by the anticonvulsant drug carbamazepine. A 7-year-old child developed symptoms consistent with DRESS syndrome following treatment with carbamazepine. The child presented with fever and a generalized rash (exanthema), prompting initial suspicion of an infectious disease, such as measles, leading to the patient’s hospitalization at an infectious disease facility. Laboratory investigations were undertaken to exclude differential diagnoses, including measles, infectious mononucleosis, lymphogranulomatosis, and leukemia. Immediate discontinuation of carbamazepine, therapeutic plasmapheresis, and initiation of prednisone therapy were implemented. This multidisciplinary approach resulted in the complete recovery of the patient and resolution of symptoms.

Keywords: DRESS/DiHS, carbamazepine, measles, herpesvirus infection, parvovirus B19.

For citation: Lebedeva T.M., Melekhina E.V., Guseva E.V., Matveychuk E.R., Muzyka A.D., Samkov A.A., Khanova D.S. DRESS syndrome: a case study of a drug-induced reaction under the guise of measles. RMJ. 2024;11:37–44. DOI: 10.32364/2225-2282-2024-11-7