Drug reaction with eosinophilia and systemic symptoms induced by carbamazepine: DRESSed to kill

Two elderly patients with dementia-related behavioral problems developed rash, edema, eosinophilia and systemic symptoms after administration of carbamazepine. Drug reaction with eosinophilia and systemic symptoms (DRESS) was diagnosed with some delay. The relevance and complexity of recognizing DRESS are shown. Symptoms occur 1 to 8 weeks after start of carbamazepine, progress slowly and are similar to those in infections and neoplastic disorders. DRESS is a severe and potentially fatal complication, occurring in 1 of every 1000 to 10,000 patients using antiepileptic drugs. Treatment consists of immediate withdrawal of the offending drug, while reexposure should be avoided. First-degree relatives need to be informed about being at increased risk.