title: Drug Reaction With Eosinophilia and Systemic Symptoms Induced by Valproic Acid: A Case Report.
abstract: BACKGROUND
  Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but life-threatening reaction to drugs such as carbamazepine and allopurinol. The condition is characterized by skin rashes, fever, hematological disturbances, lymphadenopathy, and organ failure, most probably hepatic dysfunction. To date, only a few cases of valproate-induced DRESS syndrome have been reported.
  
  
  METHODS
  We report on the case of a 60-year-old man who had been treated with valproic acid some time before being referred to Kowsar Hospital, Semnan, Iran in December 2015. He was given valproic acid 1000 mg PO, and after 20 days, he had developed widespread rashes, fever, esophagitis, cervical lymphadenopathy, and tender hepatomegaly. Laboratory results at Kowsar showed a drop in hemoglobin, in addition to lymphocytosis, thrombocytopenia, and elevated serum transaminases. DRESS was diagnosed, and corticosteroid therapy was initiated. Administration of the culprit drug to the patient was also stopped. Intravenous immunoglobulin (IVIG) improved the general condition of the patient.
  
  
  CONCLUSIONS
  Only a small number of case reports have described valproic acid-induced DRESS syndrome; therefore, the condition is difficult to prevent. Rechallenge with valproic acid should be avoided in patients with a history of reaction to the drug.
authors.affiliation: Department of Internal Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, IR Iran.
authors.forename: Mahboubeh
authors.initials: M
authors.lastname: Darban
authors.affiliation: Cancer Research Center and Department of Pharmacology, Semnan University of Medical Sciences, Semnan, IR Iran.
authors.forename: Bahador
authors.initials: B
authors.lastname: Bagheri
keywords: DRESS; Fever; Liver; Rash; Valproic Acid