Carbamazepine-Induced DRESS Syndrome with Severe Hepatic Involvement: A Case Report and Clinical Insights

Abstract

Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome represents an uncommon yet potentially fatal clinical condition. Drug-induced hypersensitivity reaction is characterised by fever, rash, haematological abnormalities and multi-organ involvement particularly the liver. Carbamazepine is a well-known trigger. Aim: The study presents a rare but serious adverse drug reaction, carbamazepine-induced DRESS syndrome with hepatic involvement. Case Presentation: A 29-year-old male with a seizure disorder on long term carbamazepine therapy presented with high grade fever, generalized erythematous rash, abdominal pain and jaundice. Laboratory findings showed leukocytosis, eosinophilia, elevated liver enzymes and hyperbilirubinemia. Methodology: Clinical evaluation, laboratory monitoring and causality assessment using the Naranjo scale (score 7) were performed. Carbamazepine was discontinued and replaced with levetiracetam along with supportive therapy. Discussion: Temporal association, clinical features and improvement after drug withdrawal confirmed carbamazepine induced DRESS with hepatic involvement. Conclusion:  The study concludes that early recognition and discontinuation of the offending drug are crucial to prevent serious complications and ensure a favourable recovery.