Lamotrigine hypersensitivity syndrome and spiking Fever

Abstract

We report a case of a 26 year old woman with rash, lymphadenopathy, liver enzyme abnormalities and spiking fever. She was diagnosed with drug-induced hypersensitivity syndrome (DHS) to lamotrigine. Spiking fever in relation to drug-induced hypersensitivity syndrome has not earlier been described in adults. Spiking fever is an important symptom of the wide spectrum of disease presentation. The syndrome is commonly referred to as either Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) or DHS. In accord with previous authors we see both syndromes as two ends of a spectrum, with a wide range of symptoms and presentations. Therefore we plea for unity in nomenclature.

Keywords: DRESS; hypersensitivity syndrome; lamotrigine; spiking fever.

Figure 1

Upon admission to the hospital, patient presented with symmetrical maculopapular exanthema and facial oedema. Furthermore lymph nodes were palpable in front of the sternocleidomastoidic muscle

Figure 2

Fever development in our patient from day of admission to the hospital. The temperature, in degree Celcius, fluctuated eleven days from febrile to non-febrile in a 2-3 day pattern. Despite of continuous acetaminophen treatment, pattern developed and remained for six days after cutaneous symptoms disappeared

Figure 3

Biopsy of skin showed several pink apoptotic keratinocytes (Civatte bodies) and mild exocystosis of lymphocytes in the epidermis as can be seen in cutaneous drug reaction. No eosinophils were present