scholarly journals Drug reaction with eosinophilia and systemic symptoms syndrome in a patient taking lamotrigine

2019 ◽  
Vol 12 (10) ◽  
pp. e229180 ◽  
Author(s):  
Catarina Lameiras ◽  
Énia Ornelas ◽  
Marta Mendes Lopes ◽  
Maria do Céu Dória
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Late Onset ◽  
Clinical Manifestations ◽  
Multiple Organ ◽  
Dress Syndrome ◽  
Causative Drug ◽  
Life Threatening ◽  
Systemic Symptoms ◽  
Hepatic Cytolysis

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare adverse drug reaction characterised by skin eruption and multiple organ involvement. Diagnosing this entity is challenging due to the variability of clinical manifestations, late onset and relapse even after stopping the causative drug. It is potentially life-threatening; thus, it must be promptly recognised and the causative drug withdrawn. We describe a case of a 50-year-old man with an acute diffuse rash, fever and eosinophilia 4 weeks after having started lamotrigine. The suspected eliciting drug was suspended and systemic corticoid treatment was initiated (prednisolone 0.5 mg/kg/day). Symptoms relapsed under corticoid tapering with greater severity. The patient developed an exuberant rash associated with peripheral lymphadenopathies, marked eosinophilia and hepatic cytolysis. The diagnosis of DRESS syndrome to lamotrigine was made. Prednisolone dosage was increased to 1 mg/kg/day, and the subsequent taper was performed slowly over the course of 10 weeks. Full clinical remission was observed.

scholarly journals A Ten-Year-Old Boy with Antiepileptic Drugs-Induced DRESS Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
S. Vithana ◽  
M. H. A. D. De Silva ◽  
G. P. Hewawitharana
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Antiepileptic Drugs ◽  
Multiorgan Failure ◽  
Maculopapular Rash ◽  
Prominent Feature ◽  
Dress Syndrome ◽  
Exfoliative Dermatitis ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction if it is not timely diagnosed and treated. This happens probably following a cascade of immune reactions after the administration of the drug ultimately leading to multiorgan failure and death. Several groups of drugs have been identified as potential aetiologies but the commonest one identified is antiepileptic drugs. The clinical features of DRESS syndrome usually appear several weeks after commencing the offending drug. Initially, fever lymphadenopathy and rash appear followed by hepatitis. Rash is the most prominent feature, and it is a generalized erythematous nonblanching maculopapular rash without the involvement of the mucus membranes or eyes. The rash desquamated over the following days and changed it’s context to an exfoliative dermatitis. We report a case of a 10-year-old boy who is one of the twins born to nonconsanguineous parents at 34 weeks of gestation.

scholarly journals DRESS Syndrome in the ICU: When a Patient Is Treated with Multiple Drugs

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Florent Moriceau ◽  
Johanne Prothet ◽  
Benjamin J. Blaise ◽  
Benoit Ben Said ◽  
Mathieu Page ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Drug Reaction ◽  
Skin Condition ◽  
Dress Syndrome ◽  
Causative Drug ◽  
Syndrome Diagnosis ◽  
Distributive Shock ◽  
Life Threatening ◽  
Systemic Symptoms ◽  
Multiple Drugs

The Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is life-threatening. It associates a skin condition with hematological and visceral disorders. The DRESS syndrome diagnosis in the intensive care unit (ICU) is difficult as clinical features are nonspecific. Furthermore, the need to treat patients with multiple drugs usually prevents the identification of the causative drug. We report the case of a patient who developed two bouts of DRESS caused by piperacillin-tazobactam, the first being complicated with a distributive shock. Cases of DRESS occurring inside ICU are seldom reported. However, any intensivist may encounter this situation during his career and should be aware of its diagnostic and management specific aspects.

Successful mepolizumab treatment for DRESS-induced refractory eosinophilic myocarditis and concurrent thyroiditis

2021 ◽  
Vol 14 (7) ◽  
pp. e242240
Author(s):  
Kelvin Truong ◽  
Shane Kelly ◽  
Angela Bayly ◽  
Annika Smith
Keyword(s):  
Adverse Drug Reaction ◽  
Clinical Trials ◽  
Drug Reaction ◽  
Mortality Rate ◽  
Prospective Studies ◽  
High Quality ◽  
Unique Case ◽  
Life Threatening ◽  
Eosinophilic Myocarditis ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening adverse drug reaction with a mortality rate of 10%. Interstitial nephritis, pneumonitis, myocarditis, meningitis, thyroiditis and pancreatitis are major causes of morbidity and mortality in this syndrome. Cessation of offending medication is paramount. There is paucity in high quality prospective studies guiding the treatment of DRESS, and there are no published therapeutic clinical trials in the treatment of corticosteroid refractory hypersensitivity myocarditis. The authors present a unique case of ciprofloxacin-induced DRESS with concurrent thyroiditis and refractory eosinophilic myocarditis that required mepolizumab and multiple immunosuppressants for successful treatment.

DRESS syndrome: an important differential for eosinophilia with systemic organ dysfunction

2020 ◽  
Vol 13 (5) ◽  
pp. e234251 ◽  
Author(s):  
Whoasif Mukit ◽  
Richard Cooper ◽  
Harmesh Moudgil ◽  
Nawaid Ahmad
Keyword(s):  
Adverse Drug Reaction ◽  
Adverse Reaction ◽  
Drug Reaction ◽  
Clinical Response ◽  
Organ Dysfunction ◽  
Patient Harm ◽  
Dress Syndrome ◽  
Cutaneous Adverse Reaction ◽  
Drug Rash ◽  
Systemic Symptoms

Drug rash occurring with eosinophilia and systemic symptoms syndrome is a potentially fatal adverse drug reaction that requires immediate action in order to minimise patient harm. Initially implicated with the use of anticonvulsants, it has also been shown to be caused by many other medications but less frequently with vancomycin. Patients typically present with fever, lymphadenopathy, eosinophilia and systemic organ dysfunction. Diagnosis is aided using probability calculators such as RegiSCAR (Registry of Severe Cutaneous Adverse Reaction), as well as clinical response on removing the responsible medication. Here, we present a case without any systemic organ dysfunction that improved with withdrawal of the offending drug vancomycin.

scholarly journals Sulfasalazine-induced DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms)

2008 ◽  
Vol 126 (4) ◽  
pp. 225-226 ◽  
Author(s):  
Renata Telles Rudge de Aquino ◽  
Carmen Silvia Vieitas Vergueiro ◽  
Maria Elisa Ruffolo Magliari ◽  
Thais Helena Proença de Freitas
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Mortality Rate ◽  
High Morbidity ◽  
Seronegative Arthritis ◽  
Dress Syndrome ◽  
Brazilian Woman ◽  
Causative Drug ◽  
Drug Rash ◽  
Systemic Symptoms

CONTEXT: DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a type of drug reaction commonly mistaken for a viral infection. It must be recognized promptly due to its high morbidity and 10% mortality rate. Few cases of DRESS syndrome induced by sulfasalazine have been reported in the literature. CASE REPORT: The case of a 47-year-old white Brazilian woman who developed DRESS syndrome eight weeks after starting a course of sulfasalazine for treatment of seronegative arthritis is reported. She presented a skin rash, fever, hepatitis, lymphadenopathy, eosinophilia and atypical lymphocytes. The causative drug was discontinued immediately, but she only improved after treatment with prednisone.

scholarly journals Phenytoin induced life threatening macroglossia in a child

2013 ◽  
Vol 04 (01) ◽  
pp. 75-77 ◽  
Author(s):  
Rakesh Mondal ◽  
Sumantra Sarkar ◽  
Tapas Sabui ◽  
Partha Pratim Pan
Keyword(s):  
Drug Reaction ◽  
Hereditary Angioedema ◽  
Dress Syndrome ◽  
Medical College ◽  
Life Threatening ◽  
Systemic Symptoms

ABSTRACTIsolated acquired macroglossia of tongue rarely reported. It occurs due to causes like hereditary angioedema, localized angioedema, etc., Here we describe an 8‑year‑old boy developing life threatening localized angioedema of tongue due to phenytoin without any association with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome or pseudolymphoma encountered in rural medical college. Anticonvulsants, that is, phenytoin induced this isolated peculiar complication, which was not described before.

scholarly journals Lamotrigine Induced DRESS Syndrome in a Child: A Case Report and Literature Review

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1063
Author(s):  
Chien-Heng Lin ◽  
Sheng-Shing Lin ◽  
Syuan-Yu Hong ◽  
Chieh-Ho Chen ◽  
I-Ching Chou
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Skin Rash ◽  
Stable Condition ◽  
Anticonvulsant Drug ◽  
Dress Syndrome ◽  
Life Threatening ◽  
History Of ◽  
History Of Epilepsy ◽  
Systemic Symptoms

Lamotrigine is an important anticonvulsant drug. Its use, however, has been limited by the risk of potentially life-threatening dermatological reactions, such as a drug reaction with eosinophilia and systemic symptoms (DRESS). Here, we report the case of a 7-year-6-month-old girl with a history of epilepsy who developed a skin rash with dyspnoea after 2 weeks of lamotrigine treatment, with DRESS ultimately being diagnosed. After discontinuation of the offending drug and the initiation of systemic glucocorticosteroids, the DRESS symptoms were relieved and the patient was discharged in a stable condition. Anticonvulsant drugs such as lamotrigine are among the factors that induce DRESS in children. When a patient displays skin rash and systemic organ involvement following the initiation of an anticonvulsant drug, DRESS should not be overlooked as a diagnosis, and immunosuppressant drugs should be considered as an option for treating DRESS patients.

scholarly journals Drug reaction with eosinophilia and systemic symptom induced by carbamazepine: a case report

2019 ◽  
Vol 8 (5) ◽  
pp. 1115
Author(s):  
Rahul R. Damor ◽  
Amita R. Kubavat ◽  
Kiran G. Piparva
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Antiepileptic Drugs ◽  
Drug Exposure ◽  
Latency Period ◽  
Systemic Symptom ◽  
Dress Syndrome ◽  
Period 2 ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening acute adverse drug reaction (ADR), typically characterized by a long latency period (2-6 weeks to 3 months) from drug exposure. DRESS syndrome is defined by the presence of fever, cutaneous eruption, lymphadenopathy, systemic or asymptomatic internal organ involvement (e.g. Hepatitis, carditis, interstitial nephritis, interstitial pneumonitis, etc.) and haematological abnormalities, mainly leucocytosis, eosinophilia and sometimes atypical lymphocytosis. There are around 50 culprit drugs which cause DRESS syndrome e.g. carbamazepine, phenytoin, allopurinol, sulfa derivatives, antidepressants, antiepileptics, non-steroidal anti-inflammatory drugs and antimicrobials. The incidence of DRESS syndrome has been estimated to be between 1 in 1,000 and 1 in 10,000 drug exposures. There are many reported cases of DRESS syndrome due to carbamazepine, phenytoin, vancomycin, levitiracitam, ceftriaxone etc. Author presented a case of DRESS syndrome by carbamazepin. RegiSCAR and Japanese consensus group have developed specific criteria for making the diagnosis of DRESS syndrome. The patient described here met the majority of criteria according to RegiSCAR scoring guidelines for a diagnosis of DRESS syndrome induced by carbamazepine. As per RegiSCAR diagnostic criteria author had concluded that this was a “Definite” case of DRESS (Drug Reaction with Eosinophilia and Systemic Symptom) syndrome induced by carbamazepine. Carbamazepine is most common broad-spectrum antiepileptic drugs so, this case report will raises awareness among physician to suspect DRESS syndrome in patients who present unusual complaints and skin findings after starting antiepileptic drugs.

scholarly journals Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide

2017 ◽  
Vol 52 (6) ◽  
pp. 408-411 ◽  
Author(s):  
Anusha Shanbhag ◽  
E. Ryan Pritchard ◽  
Kshitij Chatterjee ◽  
Drayton A. Hammond
Keyword(s):  
Drug Reaction ◽  
Hemodynamic Instability ◽  
African American Female ◽  
Probability Scale ◽  
Blood Cell Count ◽  
Dress Syndrome ◽  
Peripheral Smear ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening hypersensitivity reaction to medications. We report a case of a 75-year-old African American female who presented with generalized rash with desquamation and malodorous secretions. She was febrile and hypotensive, and required vasopressors for hemodynamic instability. Sepsis secondary to skin or soft tissue infection was considered initially. However, she recently was started on lenalidomide for treatment of her multiple myeloma, and her white blood cell count of 17 K/µL with 55% eosinophils along with peripheral smear showing eosinophilia suggested lenalidomide-induced rash. Lenalidomide was discontinued, and methylprednisolone was initiated. Four days after lenalidomide discontinuation, vasopressors were discontinued. Blood cultures did not exhibit any growth. The Niranjo Adverse Drug Reaction Probability Scale score of 9 suggests lenalidomide was a highly probable cause of DRESS syndrome. The temporal relation of lenalidomide administration and development of symptoms plus improvement of rash with the discontinuation of lenalidomide and reappearance on restarting lenalidomide in the follow-up clinic strengthens our suspicion of lenalidomide-induced DRESS syndrome. Cases of lenalidomide-induced DRESS syndrome are sparse; however, DRESS syndrome is fatal in approximately 10% of patients. Providers should be aware and keep a vigilant eye out for this adverse reaction with lenalidomide.

scholarly journals Drug Reaction with Eosinophilia and Systemic Symptoms Secondary to Naproxen: A Case Report and Literature Review

2020 ◽  
Vol 3 (2) ◽  
pp. 63-72 ◽  
Author(s):  
Sreethish Sasi ◽  
Heba Altarawneh ◽  
Mahir A. Petkar ◽  
Arun P. Nair
Keyword(s):  
Drug Reaction ◽  
Clinical Judgment ◽  
Case Reports ◽  
Clinical Status ◽  
Multiple Organ ◽  
Dress Syndrome ◽  
Macular Rash ◽  
Threatening Condition ◽  
The Face ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug reaction presenting with rash, fever, lymphadenopathy, and single or multiple organ involvement. It is most commonly associated with antiepileptics, NSAIDs, and sulfa drugs. We report a 40-year-old man who presented with a 1-week history of fever, sore throat, and a diffuse pruritic macular rash that started on the face and trunk before spreading to all extremities 4 weeks after the use of naproxen. He had lymphadenopathy, hepatosplenomegaly, transaminitis, and peripheral eosinophilia. A Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) score of 8 gave a diagnosis of definite DRESS syndrome. Significant resolution of symptoms and laboratory abnormalities were seen after 2 weeks of corticosteroid therapy. DRESS syndrome is a life-threatening condition, and the clinical status of patients can worsen rapidly. Given the high variability in clinical presentation, the diagnosis of DRESS syndrome requires a high degree of suspicion and clinical judgment. Case reports on this entity will equip physicians in acute medicine to recognize and treat the condition early. This report reinforces the importance of using the RegiSCAR score in the diagnosis of DRESS syndrome.

Sign in / Sign up

Export Citation Format

Share Document