Drug-Induced Sweet’s Syndrome by Xcopri

Main Article Content

Summer Wong
Chris Kowalczyk
Rehan Karim
Stanley Skopit
Francisco Kerdel

Keywords

epilepsy, Xcopri, Cenobamate, Sweet's Syndrome, Acute febrile neutrophilic dermatoses, medication, hypersensitivity

Abstract

Background: Sweet's syndrome (SS) is a relatively rare, self-limiting dermatological condition predominantly affecting women aged 30-50. It is characterized by the sudden onset of erythematous plaques, nodules, or papules on the skin and is often accompanied by fever, leukocytosis, and systemic symptoms. While most SS cases are idiopathic, approximately 5% are drug-induced.


Case: This case report describes a 34-year-old female with a medical history significant for epilepsy who presented with diffuse erythematous papules on the bilateral upper extremities. The onset of these symptoms coincided with the initiation of Xcopri (cenobamate tablets) in her medication regimen.


Conclusion: To our knowledge, this report highlights the first case of Xcopri-induced SS. We interpret this patient's presentation as a cutaneous response secondary to an adverse drug reaction and aim to emphasize the importance of obtaining a thorough medication history at each clinical consultation.

References

1. Cohen PR. Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis. Jul 26 2007;2:34. doi:10.1186/1750-1172-2-34

2. Keam SJ. Cenobamate: First Approval. Drugs. Jan 2020;80(1):73-78. doi:10.1007/s40265-019-01250-6

3. Nelson CA, Stephen S, Ashchyan HJ, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behcet disease. J Am Acad Dermatol. Dec 2018;79(6):987-1006. doi:10.1016/j.jaad.2017.11.064

4. Kawakami T, Ohashi S, Kawa Y, et al. Elevated serum granulocyte colony-stimulating factor levels in patients with active phase of sweet syndrome and patients with active behcet disease: implication in neutrophil apoptosis dysfunction. Arch Dermatol. May 2004;140(5):570-4. doi:10.1001/archderm.140.5.570

5. Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet's Syndrome. Front Immunol. 2019;10:414. doi:10.3389/fimmu.2019.00414

6. Taskin B, Vural S, Altug E, et al. Coronavirus 19 presenting with atypical Sweet's syndrome. J Eur Acad Dermatol Venereol. Oct 2020;34(10):e534-e535. doi:10.1111/jdv.16662

7. Sharma R, Nakamura M, Neupane C, et al. Positive allosteric modulation of GABA(A) receptors by a novel antiepileptic drug cenobamate. Eur J Pharmacol. Jul 15 2020;879:173117. doi:10.1016/j.ejphar.2020.173117