Drug-induced hypersensitivity syndrome in Infant/Neonate
The most common drugs causing this syndrome are anticonvulsants such as phenytoin, carbamazepine, phenobarbital, and lamotrigine. DIHS secondary to anticonvulsants is occasionally referred to as anticonvulsant hypersensitivity syndrome. Sulfonamide antibiotics, allopurinol, metronidazole, and abacavir are also common causes. Any new drug taken in the preceding 2 months is considered suspect. The incidence of DIHS has been estimated to be between 1 in 1000 to 1 in 10 000 exposures to drugs such as sulfonamides and anticonvulsants.
Clinically, symptoms develop 2-8 weeks after initiation of the responsible drug. If a patient is rechallenged with the drug, the reaction will occur within 24 hours. Siblings of patients with DIHS have an approximately 25% chance of a similar reaction to a culprit medication.
Special Considerations in Neonates:
DIHS / DRESS is rare in the neonatal period. Anticonvulsants are the most commonly implicated drugs. Clinical and laboratory findings are similar with those seen in the pediatric and adult populations.
L27.0 – Generalized skin eruption due to drugs and medicaments taken internally
427640001 – Non-allergic drug hypersensitivity disorder
- DIHS is often confused with mononucleosis because of the presence of atypical lymphocytes and may similarly be confused with leukemia cutis or lymphoma. Patients can have very striking lymphadenopathy that leads one to the incorrect lymphoma diagnosis. Patients with infectious mononucleosis receiving ampicillin or amoxicillin very frequently have a generalized morbilliform eruption.
- Exanthematous drug eruption
- The clinical appearance of DIHS may at times overlap with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS). These patients are best classified as having TEN or SJS; initiate treatment accordingly.
- Cytomegalovirus infection / cytomegalovirus infection of newborn
- Viral exanthem
- Erythema multiforme
- Rocky Mountain spotted fever
- Secondary syphilis
- Eosinophilic granulomatosis with polyangiitis (EGPA)