Gabapentin-induced DRESS syndrome

DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe multiorgan hypersensitivity drug reaction, which includes a maculopapular rash, fever, lymphadenopathy, hepatitis, and hematological abnormalities including eosinophilia/atypical lymphocytosis with a mortality rate of 10%. It is mostly associated with anticonvulsants, antibacterial and anti-inflammatory drugs.We present a case of Gabapentin-induced DRESS syndrome in a 66-year-old man, a diagnosed patient with diabetes mellitus and hypertension who presented with a generalized maculopapular rash mainly on the face and extremities associated with fever and lymphadenopathy. Before the hospital admission, he had been treated for Ramsay Hunt syndrome followed by herpes zoster neuralgia with gabapentin for four weeks. He had deranged liver enzymes and leukocytosis with eosinophilia on the full blood count. Physical examination and laboratory findings aided in supporting the diagnosis of Gabapentin-induced DRESS syndrome. The causative drug was discontinued immediately and he was treated with topical and oral steroids with marked clinical and biochemical response.