An infant with drug reaction with eosinophilia and systemic symptoms caused by phenobarbital and amoxicillin: A case report.

RATIONALE: Drug reaction with eosinophilia and systemic symptoms (DRESS) is rare in children, and reports of cases associated with amoxicillin (AMX), the most commonly prescribed antibiotic in children, are extremely rare. Diagnosing DRESS in infants is particularly challenging owing to its rarity and atypical symptoms, often leading to delays in diagnosis and appropriate management. Furthermore, there is insufficient reporting on the role of AMX as a trigger for DRESS in children, raising concerns about diagnostic delays.

PATIENT CONCERNS: A 12-month-old girl experienced 3 discrete episodes over 11 months after exposure to phenobarbital and later AMX, with fever, rash, eosinophilia, facial edema, and purpura.

DIAGNOSES: Recurrent DRESS attributed to phenobarbital (episode 1) and AMX (episodes 2-3), supported by positive patch tests to both drugs, a positive AMX drug provocation test, and a markedly elevated thymus and activation-regulated chemokine level in episode 3 (33,925 pg/mL); RegiSCAR scores were 5, 4, and 3, respectively.

INTERVENTIONS: In episodes 1 and 3, the patient improved with supportive therapy only. In episode 2, the patient was treated with steroids for wheezing before being suspected of DRESS symptoms.

OUTCOMES: The patient recovered fully without sequelae.

LESSONS: This case underscores the need for vigilance in diagnosing DRESS in infants, even with common antibiotics like AMX, and highlights the need for further pediatric research.