Methods: We report a case of a respective hypersensitivity to amoxicillin (AMX) and paracetamol (PARA) after DRESS syndrome to carbamazepine
Results: Case report: A 34 year-old male with a 20 year history of epilepsy was treated with valproic acid and Phenobarbital. As he had frequent convulsive fits, CBZ was added. Thirty-four days later, the patient developed hyperthermia and cervical lymphadenopathy. Initially, he was diagnosed with lymphadenitis, and, therefore, amoxicillin-clavulanic acid and paracetamol was started. Two days later, this patient developed a generalised cutaneous eruption associated to hypereosinophilia and hepatic cytolysis. He was diagnosed as DRESS syndrome. CBZ was discontinued with a favorable evolution. Six weeks after complete recovery, a patch testing to CBZ was performed. This later was strongly positive at 48 h reading. About 2 years later, the patient was treated with AMX for a dental abutment. On the 2nd day of treatment, he presented a generalised maculo-papular eruption. Laboratory findings showed a hypereosinophilia with normal hepatic and renal function. AMX was discontinued. Symptoms subsided 1 week later. Two months later, an intradermal test to AMX was performed, which was positive at 48 h reading. Four years after AMX hypersensitivity episode, this patient presented a generalised cutaneous eruption associated to eosinophilia 2 days after paracetamol intake. A patch test to paracetamol was performed six weeks after total recovery, showing a positive reaction at 48 h reading.
Conclusions: We point out a possible co-sensitisation to several chemically or antigenically unrelated drugs, CBZ on the one hand, and AMX and PARA on the other hand. Clinicians should be cautious when prescribing AMX and/or PARA to a patient with a previous history of DRESS syndrome, especially if these drugs have been administered during the DRESS episode