Drug rash with eosinophilia and systemic symptoms induced by valproate and carbamazepine: formation of circulating auto-antibody against 190-kDa antigen.
Drug rash with eosinophilia and systemic symptoms (DRESS) is characterized by fever, rash and internal organ involvement after exposure to certain drugs. Most of the aromatic anticonvulsants, such as phenytoin, phenobarbital, and carbamazepine, can induce DRESS. Cross-sensitivity between not only the aromatic anticonvulsants, but also the aromatic and non-aromatic anticonvulsants, is possible. We report here a case of a Korean woman who had previously tolerated valproate, but developed DRESS due to valproate after carbamazepine intake, which indicates cross-sensitivity. Her skin lesions displayed diffuse oedematous patches on the entire body associated with tense bullae on her arms and legs. Circulating auto-antibody to 190-kDa antigen was detected in the patient's serum by indirect immunofluorescence and immunoblotting, which might contribute to a pathogenic role in DRESS.
Yun
Sook Jung
SJ
Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea.
Lee
Jee-Bum
JB
Kim
Eun Jung
EJ
Quan
Gen
G
Kim
Seong-Jin
SJ
Won
Young-Ho
YH
Lee
Seung-Chul
SC
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects; D001323:Autoantibodies / Q000097:blood; D002220:Carbamazepine / Q000009:adverse effects; D003429:Cross Reactions; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D004802:Eosinophilia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D005260:Female; D006801:Humans; D014635:Valproic Acid / Q000009:adverse effects
D000927:Anticonvulsants; D001323:Autoantibodies; D002220:Carbamazepine; D014635:Valproic Acid