Psychotropic drug-related eosinophilia with systemic symptoms after acute caffeine ingestion.

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  • Author(s): Mahapatra S;Mahapatra S; Belgrad JL; Adeoye MA
  • Source:
    Pediatrics [Pediatrics] 2011 Jan; Vol. 127 (1), pp. e235-8. Date of Electronic Publication: 2010 Dec 06.
  • Publication Type:
    Case Reports; Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: American Academy of Pediatrics Country of Publication: United States NLM ID: 0376422 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1098-4275 (Electronic) Linking ISSN: 00314005 NLM ISO Abbreviation: Pediatrics Subsets: MEDLINE
    • Publication Information:
      Publication: Elk Grove Village Il : American Academy of Pediatrics
      Original Publication: Springfield, Ill., Thomas.
    • Subject Terms:
      Caffeine/*poisoning ; Central Nervous System Stimulants/*poisoning ; Drug Eruptions/*etiology ; Eosinophilia/*chemically induced ; Psychotropic Drugs/*adverse effects; Adolescent ; Drug Interactions ; Humans ; Male ; Syndrome
    • Abstract:
      Drug-related eosinophilia with systemic symptoms (DRESS) is a potentially life-threatening, multiorgan condition that can result from drug treatment. Antiepileptic medications have provided the best-studied link of any class of medications. Here, we report the case of a 16-year-old boy with long-standing bipolar disorder who was chronically treated with aripiprazole and fluoxetine and developed DRESS syndrome after ingestion of high doses of caffeine. His classic presentation with fever, morbilliform rash, lymphadenopathy, and visceral involvement, including leukocytosis, eosinophilia, and hepatitis, was consistent with this diagnosis. Furthermore, the patient's symptoms dramatically improved after corticosteroid therapy and discontinuation of all psychotropic medications. We propose that the development of DRESS syndrome is a net result of inconsistent medication adherence coupled with the ingestion of near-toxic doses of caffeine, which can lead to rhabdomyolysis and, through renal impairment, lead to the accumulation of toxic oxidative metabolites of either or both psychotropic medications. We also present one of the few reported cases of caffeine-induced rhabdomyolysis and propose its role in the development of DRESS in this patient.
    • Accession Number:
      0 (Central Nervous System Stimulants)
      0 (Psychotropic Drugs)
      3G6A5W338E (Caffeine)
    • Publication Date:
      Date Created: 20101208 Date Completed: 20110131 Latest Revision: 20131121
    • Publication Date:
      20221213
    • Accession Number:
      10.1542/peds.2010-0374
    • Accession Number:
      21135003