title: Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome Induced by Levetiracetam in a Pediatric Patient.
abstract: BACKGROUND
  Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, life-threatening hypersensitivity drug reaction. Patients present with cutaneous rash, fever, lymphadenopathy, hematologic abnormalities with eosinophilia and atypical lymphocytes, and visceral organ involvement. The prognosis of DRESS syndrome is related to the degree of end-organ damage, and the mortality rate is approximately 10%.
  
  
  METHODS
  We report a 9-year-old girl treated with only levetiracetam because of intracranial space occupying mass-related seizures. The patient developed pharyngitis accompanied by exudative membrane, bilateral cervical lymphadenopathy, tender hepatomegaly, skin rash, and fever after 19 days of levetiracetam therapy. Laboratory findings revealed leukocytosis, lymphocytosis with an atypical lymphocytosis, eosinophilia, thrombocytopenia, and elevated serum transaminases. Serologic studies of viruses were negative. The patient was diagnosed with DRESS syndrome and antiepileptic therapy was ceased immediately. The systemic signs and symptoms of the patient were improved after systemic steroid and antihistamine therapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important that emergency physicians be aware of the possibility of DRESS syndrome when attending children that present with clinical viral infections. We would like to emphasize that obtaining a careful and detailed medication history is an essential part of clinical assessment for the diagnosis of DRESS syndrome.
authors.affiliation: Department of Pediatric Neurology, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Ayşe Kaçar
authors.initials: AK
authors.lastname: Bayram
authors.affiliation: Department of Pediatric Neurology, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Canpolat
authors.affiliation: Department of Dermatology, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Salih Levent
authors.initials: SL
authors.lastname: Çınar
authors.affiliation: Department of Pediatric Allergy, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Fulya
authors.initials: F
authors.lastname: Tahan
authors.affiliation: Department of Pediatric Neurology, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Gumus
authors.affiliation: Department of Pediatric Neurology, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Sefer
authors.initials: S
authors.lastname: Kumandaş
authors.affiliation: Department of Pediatric Neurology, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Per
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam
keywords: DRESS syndrome; antiepileptic-induced hypersensitivity reaction; child; drug reaction; levetiracetam