양극성장애에 대한 Valproic Acid와 Olanzapine 치료 중 발생한 호산구증가증과 전신증상을 동반한 약물발진(DRESS) 증후군 1예
A Case of Drug Rash with Eosinophilia and Systemic Symptoms Associated with Valproic Acid and Olanzapine Treatment in Patient with Bipolar Disorder
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초록
Drug reaction with eosinophilia and systemic symtoms 증후군(이하 DRESS)은 1940년대 항경련제인 hydantoin을사용하면서 발생한 중증의 약물 반응을 기술하는 과정에서처음 알려졌으며,1) 이후 drug-induced hypersensitivity syndrome, 2) drug rash with eosinophilia and systemic symptoms 등 다양한 명칭으로 보고되어 왔으나 1996년 Bocquet 등3)은 약제에 의한 특이반응들을 통합하여 DRESS로 부를것을 처음 주장하였다. DRESS는 약에 의해 유발되는 과민반응으로, 발생빈도는 드물지만 피부 발진, 혈액학적 이상, 림프절 종대, 간, 신장, 폐를 비롯한 내장기관의 침범을 특징으로 하며,3)4) 10~40%의 환자에서는 치명적일 수 있다.3) Phenytoin, carbamazepine, lamotrigine을 비롯한 항경련제와allopurinol이 DRESS를 가장 흔히 유발하는 약제로 알려져있으나,5) 정신과 영역에서 많이 사용하는 valproic acid에서도 발생하며 최근 FDA6)는 olanzapine에 의해 DRESS 증후군이 발생할 수 있음을 보고한 바 있다. DRESS 증후군은 피부과 영역에서는 많이 알려져 있어 최근 국내에서도 valproic acid 사용과 관련된 증례보고가 있었으나,7) 양극성장애, 조현병, 난치성 우울증 등 다양한 질환에서 valproic acid와 olanzapine을광범위하게 사용하고 있는 정신과 영역에서는 관심도가 낮으며 증례보고도 없었다. 이에 저자들은 양극성장애환자에서 valproic acid와 olanzapine을 사용하는 중 발생한DRESS 증후군 1예를 경험하고 문헌고찰과 함께 보고한다.
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening, medication-induced hypersensitivity reaction with long latency. It is characterized by fever, rash, leukocytosis with eosinophilia, atypical lymphocytosis, and internal organ involvement. The most common causes of DRESS syndrome are sulfonamides and anticonvulsants such as carbamazepine and lamotrigine. However, valproic acid and olanzapine could develop DRESS syndrome. We report a case of DRESS syndrome associated with valproic acid and olanzapine in a 41 years old male patient with bipolar disorder.
참고문헌 (20)
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