Tected, suggesting that viral infections may serve as possible triggers for this syndrome [9]. The differential diagnosis in between respiratory infections and lung involvement in DRESS is very important in these situations. The mycoplasma speedy test in our patient was good within the ER, resulting in the initial consideration of mycoplasma pneumonia. However, right after admission, laboratory tests for mycoplasma IgG and IgM had been equivocal and unfavorable, respectively; therefore, mycoplasma infection was capable to become excluded. Our patient reported a skin rash 1 week ahead of Florfenicol amine medchemexpress arrival in the ER, followed by the improvement of fever plus the worsening of the skin rash. We speculate that a viral infection may have triggered the DRESS eruption observed within this patient. A diagnosis of DRESS is usually made determined by the diagnostic criteria established by the RegiSCAR group or those established by the Japanese Investigation Committee on Severe Cutaneous Adverse Reaction, respectively [91]. Leukocytosis with atypical lymphocytes and eosinophilia of many degrees are special Fenpropathrin supplier functions of the early phase of DRESS, while leukocytopenia can occasionally precede leukocytosis. Our patient presented with fever and skin rash, and her lab data showed leukocytosis; hence, mycoplasma pneumonia was suspected initially. Nevertheless, in tracing back our patient’s past history, it was found that she had a history of epilepsy that been controlled initially under remedy together with the anticonvulsant drug sodium valproate, which had subsequently been replaced with lamotrigine 2 weeks right after the initiation of which her skin rash 1st appeared. The patient’s skin rash and drug history were essential clues for diagnosing DRESS. Based on a overview article by Shiohara et al. [3], lamotrigine will be the fourth most common culprit amongst anticonvulsant drugs with regards to inducing DRESS. In an additional study, Newell et al. [12] reported that among 32 youngsters diagnosed with anticonvulsant hypersensitivity syndrome, 12 of them (37.5) had been taking carbamazepine, 11 of them (34.five) had been taking phenytoin, five of them (6.25) were taking phenobarbital, and five of them (six.25) have been taking lamotrigine. In still a different study, Wang et al. [13] reported that of 57 individuals with DRESS induced by lamotrigine, 14 of them (24.six) were kids. This study located a higher predominance of girls with lamotrigine-induced DRESS, but in kids, we discovered a greater predominance of lamotrigine-induced DRESS among boys (having a boy-to-girl ratio = 9:7), and we have summarized the qualities of 16 published cases of pediatric individuals with lamotrigine-induced DIHS/DRESS in Table 1. Four of them had DRESS when lamotrigine was provided concurrently with sodium valproate.Children 2021, 8,4 ofTable 1. Characteristics of youngsters (18 year-old) with lamotrigine-induced DIHS/DRESS in published case studies [124]. Case 1 two 3 4 5 six 7 8 9 10 11 12 13 14 15 16 Age/Sex 11/F 6/M 14/M 8/M 16/F 17/F 4/F 2/F 3/M 7/M 12/M 6/M 15/F 12/M 4/M 7/F Initial Dose (mg/Day) NA NA NA NA NA 50 NA NA NA NA NA NA 50 25 NA 50 Final Dose (mg/Day) NA NA NA NA NA 50 NA NA NA NA NA NA 75 50 NA 100 Latency Time (Days) NA ten 52 21 within 56 21 NA NA NA NA NA NA 30 18 30 14 Concurrent Drugs NA VPA NA None NA None NA NA NA NA NA VPA VPA 2000 mg/d VPA NA NA Therapy Steroid IVIG No steroid No steroid Steroid NA Steroid NA NA NA NA NA No steroid NA Steroid IVIG plasma exchange Steroid mycophenolate tacolimus Outcome Cured Cured Cured NA NA Cured NA NA NA NA NA Cured NA.
