A 40-year-old man develops facial edema, an extensive exanthem, eosinophil count of 2200 per cubic millimetre, and transaminases three times the upper limit 5 weeks after starting phenobarbital. Renal function is normal. What is the most appropriate immediate management?

• A Switch to another aromatic antiepileptic such as carbamazepine and review in 2 weeks
• B Stop the drug and give intravenous immunoglobulin as first-line therapy
• C Continue the drug with antipyretics and potent topical corticosteroids alone
• D Stop the drug and start systemic corticosteroids such as prednisolone 1 mg/kg/day ✓

Explanation

This is DRESS syndrome with systemic organ involvement (hepatitis and eosinophilia), so the culprit drug must be stopped immediately and systemic corticosteroids are first-line therapy to prevent progression to fulminant hepatitis or renal failure. Option A is dangerous because aromatic antiepileptics show cross-reactivity through shared metabolite pathways. Intravenous immunoglobulin is reserved for refractory or severe cases and is not first-line in standard texts.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.