A 55-year-old man presented with bilateral “splotchy vision” for 10 days. Three weeks previously, he had started lamotrigine for a seizure disorder and developed constitutional symptoms of fatigue, malaise, fever, and chills. He also developed a diffuse, nonpruritic skin rash that spread from his forearms to his trunk, flanks, and lower extremities. Systemic workup revealed elevated white blood cell count (12670.00/μL [to convert to × 109 per liter, multiply by 0.001]) with eosinophilia (8% [to convert to proportion of 1.0, multiply by 0.01]), transaminases (aspartate transaminase 92 U/L, alanine transaminase 217 U/L), and serum creatinine (1.5 mg/dL [to convert to micromoles per liter, multiply by 76.25]). A skin biopsy demonstrated a spongiotic and interface dermatitis with scattered eosinophils. He was diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and started receiving oral prednisone 60 mg/d.
Zhang AY, Yohannan J, Goldberg MF, Han IC. Acute Posterior Multifocal Placoid Pigment Epitheliopathy Associated With Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome. JAMA Ophthalmol. Published online January 05, 2017. doi:10.1001/jamaophthalmol.2016.5230