DRESS syndrome during carbamazepine treatment in a patient with drug-resistant bipolar affective disorder

Objectives.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare condition that can affect patients with diseases of any organ system.

Case report.
This article presents the clinical case of a 33-year-old woman with treatment-resistant bipolar affective disorder (BD). Due to a lack of satisfactory improvement with pharmacotherapy, the patient underwent electroconvulsive therapy (ECT). Following a shift in the phase of the disorder, combined treatment with olanzapine and carbamazepine was prescribed. After one month of using these medications, the patient developed skin lesions, including maculopapular rash, erythema, and periorbital oedema, accompanied by fever. In addition, several abnormalities were observed in routine laboratory tests, such as leukocytosis, eosinophilia, elevated CRP, ALT, AST, and GGTP levels, as well as splenomegaly. The overall clinical profile led to the diagnosis of DRESS syndrome. Treatment with dexamethasone, prednisone, loratadine, and preparations containing fluocinolone and eucerin resulted in a gradual regression of symptoms over time.

Conclusions.
The mortality rate associated with DRESS syndrome can be as high as 10%.