Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome in an Adolescent Girl With Epilepsy: A Case Report of Severe Multorgan Involvement

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially lifethreatening severe cutaneous adverse drug reaction characterized by a delayed onset of fever, extensive skin eruption, hematologic abnormalities, and internal organ involvement.Antiepileptic drugs are among the most frequently implicated medications.Early recognition and prompt withdrawal of the culprit drug with appropriate treatment are essential to prevent severe complications such as multiorgan failure.We report the case of a 15-year-old girl with autism spectrum disorder treated for uncontrolled epilepsy requiring multiple antiepileptic medications who developed severe DRESS syndrome seven to eight weeks after initiation of lamotrigine.The patient presented with mucocutaneous lesions with fever, eosinophilia, acute kidney injury, severe hepatocellular damage, respiratory manifestations, and a marked inflammatory response.DRESS was diagnosed using the RegiSCAR criteria.Carbamazepine and lamotrigine were immediately discontinued and replaced with levetiracetam.Systemic corticosteroid therapy at 1 mg/kg/day was initiated with supportive management.Despite an initial improvement, the patient's clinical condition deteriorated again, followed by fatal respiratory failure.This case highlights the diagnostic complexity and potentially fulminant course of pediatric DRESS, particularly when multiple systemic organs are involved, and urges clinicians to maintain a high index of suspicion for DRESS in children receiving aromatic antiepileptic drugs who develop fever and a generalized rash several weeks after treatment initiation.