[DRESS syndrome associated with levetiracetam use in a pediatric patient. A case report].

Abstract

Background: DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a drug-related hypersensitivity reaction that manifests with eosinophilia, systemic symptoms, and is sometimes life-threatening. It is clinically characterized by a generalized rash, fever, facial edema, and multiorgan failure. It may be accompanied by paraclinical findings such as leukocytosis, eosinophilia, and abnormalities in renal and liver function tests.

Case report: We present the case of a 10-year-old female patient hospitalized with a diagnosis of pansinusitis complicated by epidural empyema requiring surgical drainage. Prior to this, she was treated with levetiracetam. After surgery, she was maintained on a triple regimen of vancomycin, ceftriaxone, and metronidazole. Upon completion of this treatment, she developed a generalized dermatosis that did not respond to second-generation antihistamines or corticosteroids. After this, the patient presented with fever, facial edema, and a seizure. Laboratory studies were ordered, revealing leukocytosis and eosinophilia. DRESS syndrome was suspected, with a RegiSCAR score of 5, corresponding to a probable case. Treatment with immunoglobulin was initiated, with clinical improvement and resolution of the condition observed.

Conclusions: DRESS syndrome is a severe drug-induced reaction, with an estimated mortality rate of 10%. Early recognition and timely initiation of treatment are essential for prognosis and prevention of potential complications.