sechenovSechenov Medical JournalСеченовский вестник2218-73322658-3348Сеченовский Университет10.47093/2218-7332.2022.407.09sechenov-441Research ArticleINTERNAL MEDICINEВНУТРЕННИЕ БОЛЕЗНИDRESS syndrome on the background of adding meropenem to carbamazepine therapy: a clinical caseDRESS синдром на фоне добавления меропенема к терапии карбамазепином: клинический случайhttps://orcid.org/0000-0003-2455-2304ИльинаЮ. В.IlinaYu. V.

Ильина Юлия Валентиновна, канд. мед. наук, доцент кафедры терапии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Тел.: +7 (495) 623-13-76

Yulia V. Ilina, Cand. of Sci. (Medicine), Associate Professor, Therapy Department

Address: 8/2, Trubetskaya str., Moscow, 119991Tel.: +7 (495) 623-13-76

ilinayuli@yandex.ruhttps://orcid.org/0000-0003-1762-6934ФёдороваТ. А.FedorovaT. A.

Фёдорова Татьяна Алексеевна, д-р мед. наук, профессор кафедры терапии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Tatiana A. Fedorova, Dr. of Sci. (Medicine), Professor, Therapy Department

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0001-5369-987XТазинаС. Я.TazinaS. Y.

Тазина Серафима Яковлевна, д-р мед. наук, профессор кафедры терапии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Serafima Y. Tazina, Dr. of Sci. (Medicine), Professor, Therapy Department

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0003-4118-4646СотниковаТ. И.SotnikovaT. I.

Сотникова Татьяна Ивановна, канд. мед. наук, доцент кафедры терапии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Tatiana I. Sotnikova, Cand. of Sci. (Medicine), Associate Professor, Therapy Department

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0002-7884-8955СемененкоН. А.SemenenkoN. A.

Семененко Наталья Александровна, канд. мед. наук, доцент кафедры терапии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Natalya A. Semenenko, Cand. of Sci. (Medicine), Associate Professor, Therapy Department

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0002-9481-2346ЛощицН. В.LoshchitsN. V.

Лощиц Наталья Вячеславовна, заведующая терапевтическим отделением № 2

2-й Боткинский проезд, д. 5, г. Москва, 125284

Natalia V. Loshchits, Head of Therapy Department No. 2

5, 2nd Botkinsky proezd, Moscow, 125284

https://orcid.org/0000-0002-4556-6740БольшаковС. А.BolshakovS. A.

Большаков Степан Алексеевич, врач терапевтического отделения № 2

2-й Боткинский проезд, д. 5, г. Москва, 125284

Stepan A. Bolshakov, doctor at Therapy Department No. 2

5, 2nd Botkinsky proezd, Moscow, 125284

https://orcid.org/0000-0002-9575-1872КиселеваН. В.KiselevaN. V.

Киселева Наталия Владимировна, клинический ординатор кафедры терапии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Nataliia V. Kiseleva, clinical resident, Therapy Department

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0001-5031-9798ПавловЧ. С.PavlovCh. S.

Павлов Чавдар Савов, д-р мед. наук, профессор, зав. кафедрой терапии ИПО

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Chavdar S. Pavlov, Dr. of Sci. (Medicine), Professor, Head of Therapy Department, Institute of Professional Education

8/2, Trubetskaya str., Moscow, 119991

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationГБУЗ «Городская клиническая больница им. С.П. Боткина Департамента здравоохранения г. Москвы»РоссияCity Clinical Hospital named after S.P. Botkin of the Moscow Healthcare DepartmentRussian Federation2022251020211313442Copyright © Ilina Y.V., Fedorova T.A., Tazina S.Y., Sotnikova T.I., Semenenko N.A., Loshchits N.V., Bolshakov S.A., Kiseleva N.V., Pavlov C.S., 20212021Ильина Ю.В., Фёдорова Т.А., Тазина С.Я., Сотникова Т.И., Семененко Н.А., Лощиц Н.В., Большаков С.А., Киселева Н.В., Павлов Ч.С.Ilina Y.V., Fedorova T.A., Tazina S.Y., Sotnikova T.I., Semenenko N.A., Loshchits N.V., Bolshakov S.A., Kiseleva N.V., Pavlov C.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sechenovmedj.com/jour/article/view/441

DRESS syndrome is a life-threatening complication rarely encountered in clinical practice. Making a correct diagnosis is complicated not only by the similarity of the clinical manifestation with several other conditions but also delayed in time onset of the first symptoms from the “causative” drug. Along with that, timely diagnosis and early treatment reduce the risk of severe course and complications of the syndrome.Clinical case. A 29-year-old female patient was admitted to the hospital due to generalized maculopapular rash, fever, generalized lymphadenopathy, fatigue, splenomegaly appeared after adding meropenem to carbamazepine therapy. Blood tests showed leukocytosis – 33.6×109/l, hypereosinophilia – 7.9×109/l, elevated liver transaminases. After exclusion of autoimmune, infectious and oncohematological diseases the diagnose of DRESS syndrome was established. On the background of methylprednisolone therapy at the dose of 1 mg/kg fast normalization of body temperature, disappearance of rash, decrease in eosinophils were observed.Discussion. The specific feature of this clinical case is the development of DRESS syndrome after adding antibiotic to anticonvulsant drug (with which this syndrome is commonly associated). This fact complicated the diagnosis. Raising doctors’ awareness about the possibility of developing such an adverse reaction to antibiotic therapy seems to be extremely important to improve the prognosis of this group of patients.

DRESS синдром – жизнеугрожающее осложнение, редко встречающееся в клинической практике. Постановку правильного диагноза затрудняет схожесть клинических проявлений с рядом других состояний, а также отсроченная во времени от начала приема «причинного» препарата клиническая манифестация. Наряду с этим своевременные диагностика и раннее начало лечения снижают риск тяжелого течения и осложнений синдрома.Описание случая. Пациентка 29 лет госпитализирована по поводу генерализованных макуло-папулезных высыпаний, лихорадки, генерализованной лимфаденопатии, слабости, спленомегалии, появившихся на фоне добавления меропенема к терапии карбамазепином. В анализах крови обнаружен лейкоцитоз – 33,6×109/л, гиперэозинофилия – 7,9×109/л, повышение печеночных трансаминаз. После исключения аутоиммунных, инфекционных и онкогематологических заболеваний установлен DRESS синдром. На фоне терапии метилпреднизолоном в дозе 1 мг/кг веса отмечена быстрая нормализация температуры тела, исчезновение сыпи, уменьшение эозинофилов.Обсуждение. Особенностью данного клинического случая является развитие DRESS синдрома на фоне присоединения антибиотика к противосудорожному препарату (с которым наиболее часто ассоциируется этот синдром), что затруднило диагностику. Повышение информированности врачей о возможности развития такой нежелательной реакции вследствие антибиотикотерапии представляется крайне важным для улучшения прогноза данной группы пациентов.

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The authors declare that there are no conflicts of interest present.