Open AccessIntravenous immunoglobulin in the treatment of drug rash eosinophilia and systemic symptoms caused by phenytoin
Author(s) -
Ponnusamy Santhamoorthy,
K J Alexander,
Asmahan Al-Shubaili
Publication year - 2012
Publication title -
annals of indian academy of neurology (print)
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.427
H-Index - 31
eISSN - 1998-3549
pISSN - 0972-2327
DOI - 10.4103/0972-2327.104348
Subject(s) - medicine , eosinophilia , phenytoin , maculopapular rash , rash , prednisolone , dermatology , drug , hypergammaglobulinemia , antibody , surgery , immunology , pharmacology , epilepsy , psychiatry
A 32 year old Asian female on 300 mg per day of phenytoin following meningioma excision developed a fever with a diffuse maculopapular rash, lymphadenopathy and splenomegaly after12 days. A diagnosis of DRESS (Drug Rash Eosinophilia and Systemic Symptoms) syndrome was made. Patient was started on prednisolone at a dose of 1 mg/kg but since there was further deterioration in her condition, intravenous immunoglobulin was started. Clinical and blood parameters began to improve by the next day with liver functions returning to normal by the third week. DRESS syndrome is a drug hypersensitivity syndrome which can be fatal and therefore needs to be recognized early for the appropriate treatment to be started. The use of Intravenous immunoglobulins is anecdotal and the dramatic improvement noted in this case indicates that it is another treatment choice. The case and a brief review of the literature are discussed.