{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T04:49:23Z","timestamp":1770785363293,"version":"3.50.0"},"reference-count":42,"publisher":"The Pediatric Pharmacy Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially life-threatening syndrome. Herein, we present the case of a 14-year-old female who developed a diffuse erythematous rash with fever and facial edema 6 weeks after initiating treatment with carbamazepine and sertraline. Laboratory tests showed an inflammatory reaction, elevated liver enzymes, and mild eosinophilia. Serology tests were negative for viral hepatitis, cytomegalovirus, herpes simplex virus, and parvovirus B19, but positive anti-VCA IgM and anti-EBNA IgG confirmed the presence of Epstein-Barr virus reactivation. Drugs were withdrawn, and the patient was treated with corticosteroid. Carbamazepine was identified as the culprit drug after performing patch tests. Even though DRESS is rare in childhood, we present another case of carbamazepine-induced DRESS in an adolescent associated with EBV activation.<\/jats:p>","DOI":"10.5863\/jppt-24-00015","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T13:56:47Z","timestamp":1750946207000},"page":"372-375","source":"Crossref","is-referenced-by-count":1,"title":["Carbamazepine-Induced DRESS Syndrome During Epstein-Barr Virus Reactivation in an Adolescent"],"prefix":"10.5863","volume":"30","author":[{"given":"Dhouha","family":"Sahnoun","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology (DS, MA, BD, CBS), Faculty of Medicine, Sousse, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myriam","family":"Agrebi","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology (DS, MA, BD, CBS), Faculty of Medicine, Sousse, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bahaeddine","family":"Dridi","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology (DS, MA, BD, CBS), Faculty of Medicine, Sousse, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanen","family":"Zayani","sequence":"additional","affiliation":[{"name":"Department of Cardiology (HZ), Sahloul Hospital, Sousse, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lamia","family":"Boughamoura","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (LB), Farhat Hached Hospital, Sousse, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Salem C","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology (DS, MA, BD, CBS), Faculty of Medicine, Sousse, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"issue":"5","key":"i2331-348X-30-3-372-b01","series-title":"Clinical perspectives. J Am Acad Dermatol","first-page":"693.e1\u201314","article-title":"DRESS syndrome: part I","volume":"68","author":"Husain","year":"2013","unstructured":"Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: part I. Clinical perspectives. J Am Acad Dermatol. 2013;68(5):693.e1\u201314."},{"key":"i2331-348X-30-3-372-b02","series-title":"BMJ Case Rep","first-page":"bcr2017222416","article-title":"Lamotrigine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) during primary Epstein-Barr virus (EBV) infection","author":"Tawhari","year":"2018","unstructured":"Tawhari I, Tawhari F, Aljuaid M. Lamotrigine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) during primary Epstein-Barr virus (EBV) infection. BMJ Case Rep. 2018;bcr2017222416."},{"issue":"1","key":"i2331-348X-30-3-372-b03","series-title":"Pediatr Dermatol","first-page":"124","article-title":"Pediatric drug reaction with eosinophilia and systemic symptoms: a systematic review of the literature","volume":"37","author":"Metterle","year":"2020","unstructured":"Metterle L, Hatch L, Seminario-Vidal L. Pediatric drug reaction with eosinophilia and systemic symptoms: a systematic review of the literature. Pediatr Dermatol. 2020;37(1):124\u2013129."},{"key":"i2331-348X-30-3-372-b04","series-title":"Front Med","first-page":"1108345","article-title":"Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review","volume":"10","author":"Manieri","year":"2023","unstructured":"Manieri E, Dondi A, Neri I, Lanari M. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review. Front Med. 2023;10:1108345."},{"issue":"8","key":"i2331-348X-30-3-372-b05","series-title":"Int J Clin Pract","first-page":"988","article-title":"Carbamazepine-induced acute liver failure as part of the DRESS syndrome","volume":"59","author":"Syn","year":"2005","unstructured":"Syn W-K, Naisbitt DJ, Holt AP, et al. Carbamazepine-induced acute liver failure as part of the DRESS syndrome. Int J Clin Pract. 2005;59(8):988\u2013991."},{"issue":"3","key":"i2331-348X-30-3-372-b06","series-title":"Br J Dermatol","first-page":"609","article-title":"Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist?","volume":"156","author":"Kardaun","year":"2007","unstructured":"Kardaun SH, Sidoroff A, Valeyrie-Allanore L, et al. Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol. 2007;156(3):609\u2013611."},{"issue":"2","key":"i2331-348X-30-3-372-b07","series-title":"Clin Pharmacol Ther","first-page":"239","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","unstructured":"Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239\u2013245."},{"issue":"5","key":"i2331-348X-30-3-372-b08","series-title":"Dermatitis","first-page":"282","article-title":"Carbamazepine-induced DRESS with severe eosinophilia confirmed by positive patch test","volume":"25","author":"Fathallah","year":"2014","unstructured":"Fathallah N, Slim R, Rached S, et al. Carbamazepine-induced DRESS with severe eosinophilia confirmed by positive patch test. Dermatitis. 2014;25(5):282\u2013284."},{"issue":"2","key":"i2331-348X-30-3-372-b09","series-title":"Rev Esp Enferm Dig","first-page":"96","article-title":"DRESS syndrome secondary to carbamazepine","volume":"115","author":"Moreta Rodr\u00edguez","year":"2023","unstructured":"Moreta Rodr\u00edguez M, Garc\u00eda-Pajares F, Almohalla-\u00c1lvarez C, et al. DRESS syndrome secondary to carbamazepine. Rev Esp Enferm Dig. 2023;115(2):96\u201397."},{"issue":"2","key":"i2331-348X-30-3-372-b10","series-title":"Pediatr Dermatol","first-page":"229","article-title":"Drug-induced hypersensivity syndrome associated with Epstein-Barr virus infection: a pediatric case report","volume":"26","author":"Scagni","year":"2009","unstructured":"Scagni P, Morello M, Ramus MV, et al. Drug-induced hypersensivity syndrome associated with Epstein-Barr virus infection: a pediatric case report. Pediatr Dermatol. 2009;26(2):229\u2013231."},{"key":"i2331-348X-30-3-372-b11","series-title":"Pan Afr Med J","first-page":"9","article-title":"Drug reaction with eosinophilia and systemic symptom (DRESS) induced by carbamazepine: a case report and literature review","volume":"18","author":"EL omairi","year":"2014","unstructured":"EL omairi N, Abourazzak S, Chaouki S, et al. Drug reaction with eosinophilia and systemic symptom (DRESS) induced by carbamazepine: a case report and literature review. Pan Afr Med J. 2014;18:9."},{"issue":"3","key":"i2331-348X-30-3-372-b12","series-title":"J Ophthalmic Vis Res","first-page":"382","article-title":"DRESS syndrome secondary to carbamazepine therapy presenting with bilateral acute anterior uveitis and angle closure glaucoma","volume":"14","author":"Karuppannasamy","year":"2019","unstructured":"Karuppannasamy D, Andavar R, Arumugam J, et al. DRESS syndrome secondary to carbamazepine therapy presenting with bilateral acute anterior uveitis and angle closure glaucoma. J Ophthalmic Vis Res. 2019;14(3):382\u2013386."},{"issue":"1","key":"i2331-348X-30-3-372-b13","series-title":"Turk Pediatri Ars","first-page":"48","article-title":"A case of DRESS syndrome associated with carbamazepine treatment","volume":"53","author":"Dursun","year":"2018","unstructured":"Dursun A, Bayram AK, Tekerek N\u00dc, et al. A case of DRESS syndrome associated with carbamazepine treatment. Turk Pediatri Ars. 2018;53(1):48\u201350."},{"issue":"4","key":"i2331-348X-30-3-372-b14","series-title":"Australas J Dermatol","first-page":"274","article-title":"e. Patch testing is an effective method for the diagnosis of carbamazepine-induced drug reaction, eosinophilia and systemic symptoms (DRESS) syndrome in an 8-year-old girl","volume":"53","author":"Buyuktiryaki","year":"2012","unstructured":"Buyuktiryaki AB, Bezirganoglu H, Sahiner UM e. Patch testing is an effective method for the diagnosis of carbamazepine-induced drug reaction, eosinophilia and systemic symptoms (DRESS) syndrome in an 8-year-old girl. Australas J Dermatol. 2012;53(4):274\u2013277."},{"issue":"5","key":"i2331-348X-30-3-372-b15","series-title":"Pediatr Allergy Immunol","first-page":"547","article-title":"Hypersensitivity reactions to antiepileptic drugs in children","volume":"30","author":"Atanaskovi\u0107-Markovi\u0107","year":"2019","unstructured":"Atanaskovi\u0107-Markovi\u0107 M, Jankovi\u0107 J, Tmu\u0161i\u0107 V, et al. Hypersensitivity reactions to antiepileptic drugs in children. Pediatr Allergy Immunol. 2019;30(5):547\u2013552."},{"issue":"3","key":"i2331-348X-30-3-372-b16","series-title":"J Allergy Clin Immunol Pract","first-page":"811","article-title":"Virus reactivation in drug reaction with eosinophilia and systemic symptoms (Dress) results from a strong drug-specific immune response","volume":"5","author":"Roujeau","year":"2017","unstructured":"Roujeau JC, Dupin N. Virus reactivation in drug reaction with eosinophilia and systemic symptoms (Dress) results from a strong drug-specific immune response. J Allergy Clin Immunol Pract. 2017;5(3):811\u2013812."},{"issue":"5","key":"i2331-348X-30-3-372-b17","series-title":"Biomedicines","first-page":"999","article-title":"Drug reaction with eosinophilia and systemic symptoms (DReSS)\/drug-induced hypersensitivity syndrome (DiHS)-readdressing the DReSS","volume":"10","author":"Stirton","year":"2022","unstructured":"Stirton H, Shear NH, Dodiuk-Gad RP. Drug reaction with eosinophilia and systemic symptoms (DReSS)\/drug-induced hypersensitivity syndrome (DiHS)-readdressing the DReSS. Biomedicines. 2022;10(5):999."},{"issue":"2","key":"i2331-348X-30-3-372-b18","series-title":"Yonsei Med J","first-page":"317","article-title":"Anticonvulsant hypersensitivity syndrome associated with Epstein-Barr virus reactivation","volume":"48","author":"Chang","year":"2007","unstructured":"Chang JY, Kim S-C. Anticonvulsant hypersensitivity syndrome associated with Epstein-Barr virus reactivation. Yonsei Med J. 2007;48(2):317\u2013320."},{"issue":"5","key":"i2331-348X-30-3-372-b19","series-title":"Br J Dermatol","first-page":"1032","article-title":"Drug-induced hypersensitivity syndrome associated with Epstein-Barr virus infection","volume":"148","author":"Descamps","year":"2003","unstructured":"Descamps V, Mahe E, Houhou N, et al. Drug-induced hypersensitivity syndrome associated with Epstein-Barr virus infection. Br J Dermatol. 2003;148(5):1032\u20131034."},{"issue":"46","key":"i2331-348X-30-3-372-b20","series-title":"Sci Transl Med","article-title":"Drug reaction with eosinophilia and systemic symptoms (DRESS): a multiorgan antiviral T cell response","volume":"2","author":"Picard","year":"2010","unstructured":"Picard D, Janela B, Descamps V, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): a multiorgan antiviral T cell response. Sci Transl Med. 2010;2(46)."},{"issue":"5","key":"i2331-348X-30-3-372-b21","series-title":"J Am Acad Dermatol","first-page":"721","article-title":"Short- and long-term outcomes of 34 patients with drug-induced hypersensitivity syndrome in a single institution","volume":"68","author":"Ushigome","year":"2013","unstructured":"Ushigome Y, Kano Y, Ishida T, et al. Short- and long-term outcomes of 34 patients with drug-induced hypersensitivity syndrome in a single institution. J Am Acad Dermatol. 2013;68(5):721\u2013728."},{"issue":"5","key":"i2331-348X-30-3-372-b01","series-title":"Clinical perspectives. J Am Acad Dermatol","first-page":"693.e1\u201314","article-title":"DRESS syndrome: part I","volume":"68","author":"Husain","year":"2013","unstructured":"Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: part I. Clinical perspectives. J Am Acad Dermatol. 2013;68(5):693.e1\u201314."},{"key":"i2331-348X-30-3-372-b02","series-title":"BMJ Case Rep","first-page":"bcr2017222416","article-title":"Lamotrigine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) during primary Epstein-Barr virus (EBV) infection","author":"Tawhari","year":"2018","unstructured":"Tawhari I, Tawhari F, Aljuaid M. Lamotrigine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) during primary Epstein-Barr virus (EBV) infection. BMJ Case Rep. 2018;bcr2017222416."},{"issue":"1","key":"i2331-348X-30-3-372-b03","series-title":"Pediatr Dermatol","first-page":"124","article-title":"Pediatric drug reaction with eosinophilia and systemic symptoms: a systematic review of the literature","volume":"37","author":"Metterle","year":"2020","unstructured":"Metterle L, Hatch L, Seminario-Vidal L. Pediatric drug reaction with eosinophilia and systemic symptoms: a systematic review of the literature. Pediatr Dermatol. 2020;37(1):124\u2013129."},{"key":"i2331-348X-30-3-372-b04","series-title":"Front Med","first-page":"1108345","article-title":"Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review","volume":"10","author":"Manieri","year":"2023","unstructured":"Manieri E, Dondi A, Neri I, Lanari M. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review. 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Dermatitis. 2014;25(5):282\u2013284."},{"issue":"2","key":"i2331-348X-30-3-372-b09","series-title":"Rev Esp Enferm Dig","first-page":"96","article-title":"DRESS syndrome secondary to carbamazepine","volume":"115","author":"Moreta Rodr\u00edguez","year":"2023","unstructured":"Moreta Rodr\u00edguez M, Garc\u00eda-Pajares F, Almohalla-\u00c1lvarez C, et al. DRESS syndrome secondary to carbamazepine. Rev Esp Enferm Dig. 2023;115(2):96\u201397."},{"issue":"2","key":"i2331-348X-30-3-372-b10","series-title":"Pediatr Dermatol","first-page":"229","article-title":"Drug-induced hypersensivity syndrome associated with Epstein-Barr virus infection: a pediatric case report","volume":"26","author":"Scagni","year":"2009","unstructured":"Scagni P, Morello M, Ramus MV, et al. Drug-induced hypersensivity syndrome associated with Epstein-Barr virus infection: a pediatric case report. Pediatr Dermatol. 2009;26(2):229\u2013231."},{"key":"i2331-348X-30-3-372-b11","series-title":"Pan Afr Med J","first-page":"9","article-title":"Drug reaction with eosinophilia and systemic symptom (DRESS) induced by carbamazepine: a case report and literature review","volume":"18","author":"EL omairi","year":"2014","unstructured":"EL omairi N, Abourazzak S, Chaouki S, et al. Drug reaction with eosinophilia and systemic symptom (DRESS) induced by carbamazepine: a case report and literature review. Pan Afr Med J. 2014;18:9."},{"issue":"3","key":"i2331-348X-30-3-372-b12","series-title":"J Ophthalmic Vis Res","first-page":"382","article-title":"DRESS syndrome secondary to carbamazepine therapy presenting with bilateral acute anterior uveitis and angle closure glaucoma","volume":"14","author":"Karuppannasamy","year":"2019","unstructured":"Karuppannasamy D, Andavar R, Arumugam J, et al. DRESS syndrome secondary to carbamazepine therapy presenting with bilateral acute anterior uveitis and angle closure glaucoma. J Ophthalmic Vis Res. 2019;14(3):382\u2013386."},{"issue":"1","key":"i2331-348X-30-3-372-b13","series-title":"Turk Pediatri Ars","first-page":"48","article-title":"A case of DRESS syndrome associated with carbamazepine treatment","volume":"53","author":"Dursun","year":"2018","unstructured":"Dursun A, Bayram AK, Tekerek N\u00dc, et al. A case of DRESS syndrome associated with carbamazepine treatment. Turk Pediatri Ars. 2018;53(1):48\u201350."},{"issue":"4","key":"i2331-348X-30-3-372-b14","series-title":"Australas J Dermatol","first-page":"274","article-title":"e. Patch testing is an effective method for the diagnosis of carbamazepine-induced drug reaction, eosinophilia and systemic symptoms (DRESS) syndrome in an 8-year-old girl","volume":"53","author":"Buyuktiryaki","year":"2012","unstructured":"Buyuktiryaki AB, Bezirganoglu H, Sahiner UM e. Patch testing is an effective method for the diagnosis of carbamazepine-induced drug reaction, eosinophilia and systemic symptoms (DRESS) syndrome in an 8-year-old girl. Australas J Dermatol. 2012;53(4):274\u2013277."},{"issue":"5","key":"i2331-348X-30-3-372-b15","series-title":"Pediatr Allergy Immunol","first-page":"547","article-title":"Hypersensitivity reactions to antiepileptic drugs in children","volume":"30","author":"Atanaskovi\u0107-Markovi\u0107","year":"2019","unstructured":"Atanaskovi\u0107-Markovi\u0107 M, Jankovi\u0107 J, Tmu\u0161i\u0107 V, et al. Hypersensitivity reactions to antiepileptic drugs in children. Pediatr Allergy Immunol. 2019;30(5):547\u2013552."},{"issue":"3","key":"i2331-348X-30-3-372-b16","series-title":"J Allergy Clin Immunol Pract","first-page":"811","article-title":"Virus reactivation in drug reaction with eosinophilia and systemic symptoms (Dress) results from a strong drug-specific immune response","volume":"5","author":"Roujeau","year":"2017","unstructured":"Roujeau JC, Dupin N. Virus reactivation in drug reaction with eosinophilia and systemic symptoms (Dress) results from a strong drug-specific immune response. J Allergy Clin Immunol Pract. 2017;5(3):811\u2013812."},{"issue":"5","key":"i2331-348X-30-3-372-b17","series-title":"Biomedicines","first-page":"999","article-title":"Drug reaction with eosinophilia and systemic symptoms (DReSS)\/drug-induced hypersensitivity syndrome (DiHS)-readdressing the DReSS","volume":"10","author":"Stirton","year":"2022","unstructured":"Stirton H, Shear NH, Dodiuk-Gad RP. Drug reaction with eosinophilia and systemic symptoms (DReSS)\/drug-induced hypersensitivity syndrome (DiHS)-readdressing the DReSS. Biomedicines. 2022;10(5):999."},{"issue":"2","key":"i2331-348X-30-3-372-b18","series-title":"Yonsei Med J","first-page":"317","article-title":"Anticonvulsant hypersensitivity syndrome associated with Epstein-Barr virus reactivation","volume":"48","author":"Chang","year":"2007","unstructured":"Chang JY, Kim S-C. Anticonvulsant hypersensitivity syndrome associated with Epstein-Barr virus reactivation. Yonsei Med J. 2007;48(2):317\u2013320."},{"issue":"5","key":"i2331-348X-30-3-372-b19","series-title":"Br J Dermatol","first-page":"1032","article-title":"Drug-induced hypersensitivity syndrome associated with Epstein-Barr virus infection","volume":"148","author":"Descamps","year":"2003","unstructured":"Descamps V, Mahe E, Houhou N, et al. Drug-induced hypersensitivity syndrome associated with Epstein-Barr virus infection. Br J Dermatol. 2003;148(5):1032\u20131034."},{"issue":"46","key":"i2331-348X-30-3-372-b20","series-title":"Sci Transl Med","article-title":"Drug reaction with eosinophilia and systemic symptoms (DRESS): a multiorgan antiviral T cell response","volume":"2","author":"Picard","year":"2010","unstructured":"Picard D, Janela B, Descamps V, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): a multiorgan antiviral T cell response. Sci Transl Med. 2010;2(46)."},{"issue":"5","key":"i2331-348X-30-3-372-b21","series-title":"J Am Acad Dermatol","first-page":"721","article-title":"Short- and long-term outcomes of 34 patients with drug-induced hypersensitivity syndrome in a single institution","volume":"68","author":"Ushigome","year":"2013","unstructured":"Ushigome Y, Kano Y, Ishida T, et al. Short- and long-term outcomes of 34 patients with drug-induced hypersensitivity syndrome in a single institution. 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