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 Pseudomembranous colitis in a patient with lamotrigine-induced drug rash with eosinophilia and systemic symptoms syndrome

2016 ◽  
Vol 7 (1) ◽  
Author(s):  
Manuel Soria Orozco ◽  
Eduardo Martín Nares ◽  
Alvaro López Iñiguez ◽  
Sandra Gónzalez Saldaña ◽  
Lorena Valerdi Contreras ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Gastrointestinal Tract ◽  
Liver Function ◽  
Hypersensitivity Reaction ◽  
Pseudomembranous Colitis ◽  
Hispanic Woman ◽  
Gastrointestinal Involvement ◽  
Dress Syndrome ◽  
Drug Rash ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity reaction with rash, fever and multiorgan dysfunction potentially lethal in up to 10% of cases. It often affects liver function, but it can also affect kidney, lungs, and heart. Severe gastrointestinal involvement is rare. We present a case of a 31-year-old hispanic woman with pseudomembranous colitis associated with lamotrigine-induced DRESS syndrome. To the best of our knowledge, this is the fourth reported case of severe involvement of the gastrointestinal tract and the first to report pseudomembranous colitis in the setting of DRESS syndrome.

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 Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A case with adverse reaction to three drugs alternately administered

2021 ◽  
Vol 4 (1) ◽  
pp. 001-005
Author(s):  
Manieri Sergio ◽  
Mirauda Maria P ◽  
De Gregorio Fabiola ◽  
Colangelo Carmela ◽  
Tagliente Maria ◽  
...  
Keyword(s):  
Adverse Reaction ◽  
Drug Reaction ◽  
Case Report ◽  
Mortality Rate ◽  
Hypersensitivity Reaction ◽  
Genetic Predisposition ◽  
Intravenous Immunoglobulins ◽  
Dress Syndrome ◽  
Pediatric Case ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multiorgan hypersensitivity reaction mostly caused by several eliciting drugs in patients with a genetic predisposition. Incidence of DRESS in children is very variable, frome 1:1000 to 1:10.000, and the mortality rate seems to be lower than 10%. Anti-convulsants are the main drugs involved both in adults and in children. The treatment of choice is the prompt withdrawn of the offending drug and using intravenous immunoglobulins and corticosteroids used in synergy. In recent years, emerging studies have outlined the disease more clearly. We present a pediatric case in which the patient developed DRESS syndrome as a result of exposure to lamotrigine before and carbamazepine after and a relapse after exposure to omeprazole. Starting from this case report we provide an overview on DRESS Syndrome.

Drug reaction with eosinophilia and systemic symptoms syndrome secondary to acetazolamide associated with markedly elevated procalcitonin

2021 ◽  
Vol 14 (1) ◽  
pp. e236966
Author(s):  
Syed Basharat Ali ◽  
Sacha Schweikert ◽  
Anna Brusch
Keyword(s):  
Septic Shock ◽  
Drug Reaction ◽  
Organ Dysfunction ◽  
Clinical Assessment ◽  
Dress Syndrome ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an important cause of multi-organ dysfunction and can mimic other disorders including sepsis. We describe a patient presenting with septic shock and accompanying high procalcitonin. Although initially treated empirically with antibiotics, the emergence of eosinophilia during the admission lead to a revised diagnosis of DRESS syndrome, presumed secondary to acetazolamide. This case highlights the importance of regular clinical assessment and re-evaluation is key in identifying emerging features such as eosinophilia, rash and organ dysfunction, which can secure the diagnosis. Furthermore, the case also highlights that acetazolamide may be a rare cause of DRESS syndrome.

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 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 Raltegravir-associated Drug-Reaction With Eosinophilia and Systemic Symptoms Syndrome in a Pediatric Patient Without Characteristic Human Leukocyte Antigen B*57:01 or B*53:01 alleles

2020 ◽  
Author(s):  
Sanya J Thomas ◽  
Jacob T Kilgore ◽  
Bradford A Becken ◽  
Coleen K Cunningham ◽  
Amelia B Thompson
Keyword(s):  
Drug Reaction ◽  
Human Leukocyte Antigen ◽  
Human Leukocyte ◽  
African American Female ◽  
Dress Syndrome ◽  
Leukocyte Antigen ◽  
Antigen B ◽  
Immunodeficiency Virus ◽  
Perinatally Acquired ◽  
Systemic Symptoms

Abstract We present the first published case of raltegravir-associated drug-reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a child without characteristic human leukocyte antigen haplotypes HLA-B*57:01 or HLA-B*53:01. A 4-year-old African American female with perinatally acquired human immunodeficiency virus infection was hospitalized for DRESS after starting a raltegravir-based antiretroviral regimen.

scholarly journals Therapeutic Trial of Rifabutin After Rifampicin-Associated DRESS Syndrome in Tuberculosis-Human Immunodeficiency Virus Coinfected Patients

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Rannakoe J. Lehloenya ◽  
Sipho Dlamini ◽  
Rudzani Muloiwa ◽  
Betty Kakande ◽  
Mzudumile R. Ngwanya ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Clinical Management ◽  
Cross Reactivity ◽  
Therapeutic Trial ◽  
Drug Reactions ◽  
Dress Syndrome ◽  
Drug Eruptions ◽  
Immunodeficiency Virus ◽  
Drug Rash ◽  
Systemic Symptoms

Abstract Elimination of a rifamycin from the treatment regimen for tuberculosis negatively impacts outcomes. Cross-reactivity between the rifamycins after drug eruptions is unclear. We report 6 consecutive human immunodeficiency virus-infected patients with rifampicin-associated drug rash with eosinophilia and systemic symptoms (DRESS) syndrome confirmed on diagnostic rechallenge. The patients subsequently tolerated rifabutin. These data inform clinical management of tuberculosis-associated drug reactions.

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