Atypical, Levetiracetam-induced Hypersensitivity Syndrome Complicated by Fulminant Liver Failure in a Patient Undergoing Hemodialysis

Drug reaction with eosinophilia and systemic symptoms (DRESS) associated with the use of antiseizure medications-An overview of clinical data

The United States Food and Drug Administration (US FDA) released a warning regarding Drug Reactions with Eosinophilia and Systemic Symptoms (DRESS) linked to the use of antiseizure drugs, including levetiracetam and clobazam, on November 28, 2023. Hence, our review focuses on DRESS associated with the use of antiseizure drugs, including Levetiracetam, Clobazam, Carbamazepine, Phenytoin, Phenobarbital, Valproate, Oxcarbazepine, and Lamotrigine. The online databases, such as Medline/Pubmed/PMC, Scopus, Web of Science, Google Scholar, Science Direct, Ebsco, Embase, and reference lists, were searched for relevant publications. Several case reports and reviews of pharmacovigilance data by different regulatory bodies were published regarding DRESS associated with antiseizure drugs. Management strategies for DRESS may include immediate discontinuation of offending medication, administration of systemic corticosteroids, and administration of cyclosporine and intravenous immunoglobulin in cases that are not responding to systemic corticosteroids. Early detection and treatment of DRESS by healthcare professionals is necessary to lower mortality and improve outcomes. The US FDA advises healthcare professionals to be aware of the connection between DRESS and specific antiseizure medications. Patients should be informed by medical professionals about the symptoms and signs of DRESS as well as the risks associated with it. In conclusion, DRESS syndrome, though rare, is a serious hypersensitivity reaction linked to antiseizure drugs like levetiracetam and clobazam. Early detection and discontinuation of the offending drug, coupled with systemic corticosteroids, are essential for effective management. Healthcare professionals must be vigilant in identifying DRESS to reduce mortality and improve patient outcomes.

Fatal outcome related to drug reaction with eosinophilia and systemic symptoms: a disproportionality analysis of FAERS database and a systematic review of cases

Background

Drug rash with eosinophilia and systemic symptoms (DRESS) is a life-threatening severe cutaneous adverse reaction.

Objective

This study aims to study fatal DRESS cases using FAERS database and systematic review.

Methods

Data of the FDA Adverse Event Reporting System (FAERS) database were extracted and manipulated. Articles from Pubmed, Embase and CINAHL databases were screened.

Results

0.13% of the adverse events submitted to FAERS was identified as DRESS and the percentage of fatal cases was up to 6.62%. The top five drugs calculated to induce DRESS with the highest number of reported cases were allopurinol, lamotrigine, vancomycin, amoxicillin and carbamazepine. The top five drugs statistically related to fatal outcome with the highest number of reported cases were allopurinol, vancomycin, trimethoprim, sulfamethoxazole and lamotrigine. Skin manifestations remained the main reason for admission and the average time from dose to rash onset was 27.19 days. The most commonly cited culprit medication type were antibiotics (50.00%), anti-gout agents (15.38%) and anti-epileptic drug (11.54%).

Conclusions

We discussed fatal cases of DRESS through FAERS system and case reports, hoping to raise awareness when using relevant drugs.