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All Journal ODONTO Dental Journal Odonto dental journal Acta Neurologica Indonesia
Pangeran, David
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Health Professions Medicine & Pharmacology Neuroscience Public Health

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Journal : ODONTO Dental Journal

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Challenges in Managing Oral Manifestations of Anticonvulsant-Induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome Fajrin, Fildzah Nurul; Wardhany, Indriasti Indah; Rahmayanti, Febrina; Ikhsan, Muhammad; Pangeran, David
Odonto : Dental Journal Vol 12, No 3 (2025): December 2025
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.12.3.332-345

Abstract

Background : Antiepileptic drugs were common causative agents for DRESS syndrome, which was a severe, idiosyncratic drug hypersensitivity reaction characterized by a prolonged latency period, fever, rash, and marked eosinophilia. The oral manifestations present a diagnostic challenge due its similarity to other hypersensitivity reactions as well as its comprehensive management. Objective: This case report aims to describe the challenges in comprehensive management of DRESS syndrome severe oral manifestations, highlighting the  challenges from diagnosis to management for patient with complex comorbidities. Case: A 19-year-old female inpatient was referred to Oral Medicine division, Dental and Oro-maxillofacial unit of Universitas Indonesia Hospital  (RSUI) for severe oral sores after treated with phenytoin and lamotrigine for her temporal lobe epilepsy and bipolar affective disorder. Patient shows general weakness and clinical examination revealed multiple intra oral erosions, lips erosions with exfoliation and haemorrhagic crust, generalized maculopapular rash, facial oedema, tender lymphadenopathy, and. Laboratory findings confirmed a severe hyper-eosinophilia (32%) and lymphopenia (13.5%), while liver function was normal. A diagnosis of DRESS syndrome was finally established. Case management were immediate withdrawal of phenytoin and lamotrigine, followed by multidisciplinary care including intra vena and topical corticosteroids. The patient's condition significantly improved after collaborative comprehensive treatment. Conclusion: Definitive diagnosis decisions requires careful consideration on the correlation of clinical findings, medication history, and hallmark laboratory results, especially in patients with complex comorbidities and intraoral clinical features with characteristics similar to other hypersensitivity reactions. Comprehensive collaborative management, including patient’s and other healthcare professionals collaboration, is crucial for successful treatment.
Co-Authors Al Rasyid Alsakina, Nashiha Anna Mira Lubis Delarosa, Dinda Olinda Dewi Wulandari Febrina Rahmayanti Fildzah Nurul Fajrin, Fildzah Nurul Fitri Octaviana Imran, Darma Indriasti Indah Wardhany Jeremia, Ivan Kevin Gunawan Kurniawan, Mohammad Lisa Agustina, Lisa Maharani, Kartika Marwadhani, Sarah Shafa Mohamad Saekhu Muhammad Ikhsan Nagpal, Chand Dhiraj Ni'am, Syauqi Faidhun Pradiptaloka, Ediva Putri, Stefanie Karina Rahmadi, Ikhlas Rahmana, Arizari Haj Rakhmad Hidayat Rima, Siti Pujiwati Permata Ririhena, Fiorentina Cemerlang Riwanti Estiasari Salim Harris, Salim Saputri, Liana Alviah Siniwali, Ida Mas Ayu Taufik Mesiano Ulwanda, Ramadhanti Salma