DRESS syndrome induced by clobazam in a child: A new case

Introduction. - Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially life-threatening adverse drug reaction. Antiepileptic drugs are the most frequently reported cause of DRESS, especially carbamazepine, lamotrigine and phenobarbital, but infrequently clobazam. We report a new case of DRESS syndrome induced by clobazam in a child. Patients and methods. - A 13-year-old girl with a history of a behavioral disorder with mental retardation since the age of six years had been taking risperidone for two years, followed by clobazam, after the onset of convulsive seizures one month before she was hospitalized. Three weeks after initiation of clobazam she presented an erythematous morbilliform rash with facial edema (chiefly palpebral), polyadenopathy and fever of 39 degrees C. Laboratory tests showed hypereosinophilia, liver damage (elevated liver transaminases at 5 x ULN). Based on the diagnostic criteria and chronology, a diagnosis was made of DRESS syndrome induced by clobazam. The patient was started on systemic steroid therapy at 0.5 mg/kg/day. An improvement in clinical symptoms and laboratory abnormalities was noted after 7 days of treatment and immediate withdrawal of the suspected drug. Discussion. - Antibiotics appear to be the main culprit in DRESS syndrome in children, followed by antiepileptic drugs other than clobazam, which has consistently been the safest anticonvulsant in terms of the rarity of side effects. However, a very small number of cases of toxic epidermal necrolysis has been reported. Reports of DRESS syndrome with clobazam in are very infrequent. (C) 2019 Elsevier Masson SAS. All rights reserved.