Carbamazepine-induced DRESS syndrome with recurrent fever and exanthema

A 43‐year‐old woman was admitted to hospital with a history of recurrent attacks of vertigo, which had been treated with carbamazepine for 4 weeks. The patient presented with fever, cold chills, lymphadenopathy, and erythematous and highly infiltrated skin. The Nikolski phenomenon was negative and there was no pruritus. Symptoms had begun 5 days earlier, with a diffuse maculopapular exanthema, first localized on the breast and trunk, with consecutive generalization, and accompanied by a severe enteritis. The exanthema worsened to a state of generalized erythroderma (Fig. 1). 1 The patient's left arm and right hand showing infiltrated, edematous, and erythematous skin with a hemorrhagic aspect The patient's performance status was 2, according to the World Health Organization (WHO). Laboratory findings showed a white blood cell count of 22.4 × 109/L [normal, (4.0–10.0) × 109/L] with 32% eosinophils (normal, up to 4% of total circulating leukocytes), an aspartate aminotransferase (ASAT) level of 63 U/L (normal, 0–15 U/L), an alanine aminotransferase (ALAT) level of 95 U/L (normal, 0–19 U/L), a γ‐glutamyl transpeptidase (γ‐GT) level of 176 U/L (normal, 4–18 U/L), and an alkaline phosphatase (AP) level of 305 U/L (normal, 60–170 U/L). The C‐reactive protein (CRP) level was 8.9 mg/dL (normal,