Reactions 1406 - 16 Jun 2012

SClomipramine

DRESS syndrome with pulmonary involvement:case report

A 47-year-old woman developed DRESS syndrome withpulmonary involvement during treatment withclomipramine [route and frequency not stated].

The woman was hospitalised with cough and dyspnoea.She had been receiving clomipramine 50mg for the last4 weeks in addition to bromazepam for a depressivesyndrome. In addition to her progressive respiratorysymptoms, she had experienced asthenia for the lastmonth. Examination revealed a slight fever, atranscutaneous oxygen saturation of 96%, BP130/80mm Hg, and basal crepitant rales. Lymph nodeexamination revealed multiple centimetric inguinal andcervical adenopathies. A chest x-ray showed retrocardiacalveolar condensation associated with a bilateral hilarenlargement. A thoracic angiography showed multiplebilateral ground glass opacities and septa thickening. Acomplete blood count indicated hyperleucocytosis and herLDH level was 608 IU/L. A bronchial aspiration culture wasinflammatory and revealed eosinophils. Thebronchoalveolar lavage revealed intense eosinophilicalveolitis. HHV-6 serology showed slightly positive IgG.Epstein-Barr virus serology was positive for EBV-VCA IgGand EBNA IgG antibodies.

Clomipramine was discontinued on the second day ofthe woman’s hospitalisation. On hospital day 4, shepresented with a pruritic vesicular rash for 24 hours. A skinbiopsy revealed a perivascular inflammatory infiltrate. Thehistological appearance was consistent with a drugreaction. The level of polynuclear eosinophils increasedand reached 7.11 G/L on day 7. Her hypereosinophiliareduced progressively from hospital day 8 and normalisedon day 13. Her chest CT scan was normal 1 month afterclomipramine discontinuation.

Author comment: We report a case of acute eosinophilicpneumopathy whose originality consists in being part of aDRESS syndrome induced by clomipramine.Gallego J, et al. Clomipramine hypersensitivity with predominantly pulmonaryinvolvement. Revue des Maladies Respiratoires 29: 430-434, No. 3, Mar 2012.Available from: URL: http://dx.doi.org/10.1016/j.rmr.2012.01.006 [French;summarised from a translation] - France 803072160

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Reactions 16 Jun 2012 No. 14060114-9954/10/1406-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved