(BMJ) - A 16-yo boy on phenytoin and folic acid x 6 weeks presents w/ fever, jaundice, generalized eruption, and hepatomegaly. Labs: elevated LFTs, CBC w/ leukocytosis, eosinophilia. Rash evolved from maculopapular to desquamative to exfoliative. What is it?
DRESS Syndrome (Drug Rash Eosinophilia and Systemic Symptoms)
Stevens-Johnson syndrome
Epstein-Barr virus
Kawasaki Disease
Shingles
You are correct. Anticonvulsants like phenytoin are a common cause of DRESS syndrome. Typical features include fever, exfoliative dermatitis, adenopathy, eosinophilia and hepatitis. The patient improved over a period of 3 weeks after phenytoin discontinuation and a prednisolone taper.