scholarly journals DRESS Syndrome due to Nevirapine Treated with Methylprednisolone

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Henrique Pott Junior ◽  
Gisele Cristina Gosuen ◽  
Ana Cristina Gales
Keyword(s):  
Clinical Presentation ◽  
Mortality Rates ◽  
Multiple Organ ◽  
Clinical Suspicion ◽  
Significant Morbidity ◽  
Dress Syndrome ◽  
Infected Female ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Symptoms

Nevirapine-induced DRESS syndrome is uncommon but a potentially life-threatening condition, with significant morbidity and mortality rates due to multiple-organ involvement. The authors report a case of a 47-year-old HIV-infected female patient who presented with fever, right hypochondrium pain, jaundice, and skin rash. The Nevirapine-induced DRESS syndrome was suspected based on clinical presentation and RegiSCAR scoring system. This case highlights the need for a high index of clinical suspicion among HIV-infected patients with severe skin eruption and systemic symptoms.

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.

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 Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome induced by ceftriaxone with successful treatment — A case report and literature review

2022 ◽  
Vol 8 (4) ◽  
pp. 298-300
Author(s):  
Arpit Agrawal ◽  
Pankaj Kannauje
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Literature Review ◽  
Sore Throat ◽  
Hypersensitivity Reactions ◽  
Dress Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Symptoms ◽  
Prolonged Latency

Drug reaction with eosinophilia and systemic symptoms is a rare and potentially life threatening condition characterised by hypersensitivity reactions to a drug with prolonged latency, in the form of skin rashes, hyper eosinophilia and systemic features like fever, lymphadenopathy, leucocytosis, internal organ involvement (liver, kidney, lung). Though it can occur in response to many drugs but very few cases has been described in relation to one of the most commonly used antibiotic ceftriaxone. Here we have described a case of DRESS in a patient who has been treated with ceftriaxone outside our hospital for sore throat.

scholarly journals Hepatic manifestations of drug reaction with eosinophilia and systemic symptoms syndrome

2021 ◽  
Author(s):  
Maria Gabriela Delgado ◽  
Stefania Casu ◽  
Matteo Montani ◽  
Felix Brunner ◽  
Nasser Semmo ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Acute Hepatitis ◽  
Clinical Presentation ◽  
Dress Syndrome ◽  
Multiple Organs ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening drug reaction, which can affect multiple organs. Patients with DRESS syndrome and hepatic manifestations may present alterations ranging from mild hepatitis to acute liver failure. The diagnosis might be difficult, and the management of these patients is challenging. This report analyzes a series of five cases reporting the clinical presentation, which ranged from acute hepatitis to liver failure, and discussed their treatment.

EBV Reactivation in A Case of DRESS Syndrome Associated with Lamotrigine – A Case Report

2021 ◽  
Vol 03 ◽  
Author(s):  
Mahmoud Ahmed Kiblawi ◽  
Mohamad El Saleh ◽  
Ashraf El Ghul
Keyword(s):  
Drug Reaction ◽  
Hypersensitivity Reaction ◽  
Topical Steroids ◽  
Dress Syndrome ◽  
Case Presentation ◽  
Ebv Reactivation ◽  
Culprit Drug ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Symptoms

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is a rare, T-cell mediated hypersensitivity reaction that develops secondary to a drug reaction. Several drugs have been associated with DRESS syndrome, most commonly carbamazepine. The mechanism is not clearly understood. It is a life-threatening condition that can present with skin rash, hematologic abnormalities, lymphadenopathy, and organ failure. Case Presentation: The authors report a case of 43-year-old gentleman who developed DRESS syndrome secondary to lamotrigine and was found to have EBV reactivation. Patient was managed with supportive care; topical steroids and the culprit drug were discontinued. He had full recovery almost 2 weeks following treatment. DRESS syndrome can occur 2 weeks following exposure to an offending drug in susceptible individuals. Conclusion: Lamotrigine and EBV reactivation are not frequently reported in patients with DRESS syndrome. Therefore, physicians should be vigilant about this rare drug related hypersensitivity reaction in order to prevent life threatening complications.

scholarly journals Spontaneous Splenic Rupture Complicating Severe P. falciparum Infection: A Case Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Eltaib Saad ◽  
Elamin Elsamani ◽  
Walid Abdelrahman
Keyword(s):  
Clinical Presentation ◽  
Splenic Rupture ◽  
Clinical Suspicion ◽  
Successful Outcome ◽  
Spontaneous Splenic Rupture ◽  
Malarial Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Missed Diagnosis ◽  
Rupture Of The Spleen

Spontaneous rupture of the spleen in malarial infection or malarial splenic rupture (MSR) is a rare but life-threatening condition complicating severe malarial infection in tropics and subtropics, and hence it deserves special attention. A high index of clinical suspicion is warranted for the early diagnosis as delayed or missed diagnosis can be potentially fatal. We report on a 32-year-old male who was diagnosed with severe Plasmodium falciparum infection and presented with an acute abdomen due to spontaneous splenic rupture. He was managed conservatively and had a successful outcome. The epidemiology, pathophysiology, clinical presentation, and management of MSR were briefly discussed in this report.

scholarly journals Profound Metabolic Acidosis due to Metformin Intoxication Requiring Dialysis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Klodia Hermez ◽  
Carla Dudash-Mion
Keyword(s):  
Renal Function ◽  
Lactic Acid ◽  
Metabolic Acidosis ◽  
Mortality Rates ◽  
Clinical Suspicion ◽  
Intermittent Hemodialysis ◽  
Unique Case ◽  
Threatening Condition ◽  
Bicarbonate Therapy ◽  
Life Threatening

Metformin-associated lactic acidosis (MALA) is a rare but life-threatening condition with often high mortality rates. Despite this, metformin continues to be one of the most commonly prescribed antihyperglycemic agents in the market. We present a unique case of a 61-year-old female with severe acidosis of pH = 6.72 and lactic acid of 26 mmol/L who presented obtunded after ingestion of an unknown amount of metformin. She was subsequently intubated, became hypotensive, and was initiated on vasopressors. She was swiftly started on a combination of intermittent hemodialysis (IHD) and bicarbonate therapy 7 hours after admission followed by continuous renal replacement therapy (CRRT) as she became more hemodynamically unstable. The patient’s renal function improved, and she was discharged 7 days after admission with favorable sequelae. Dialysis is often reported in cases of severe MALA; however, it remains unclear how quickly dialysis should be initiated. This case aims to explore the benefits of quick initiation of extracorporeal measures in the forms of IHD and CRRT with concurrent bicarbonate supplementation. Furthermore, this case demonstrates the importance of clinical suspicion in metabolic acidosis in a patient on metformin therapy.

scholarly journals Myelodysplastic Syndrome Clinically Presenting with the “Classic TTP Pentad”

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Santiago Fabián Moscoso Martínez ◽  
Evelyn Carolina Polanco Jácome ◽  
Elizabeth Guevara ◽  
Vijay Mattoo
Keyword(s):  
Myelodysplastic Syndrome ◽  
Clinical Presentation ◽  
Renal Involvement ◽  
Medical Emergency ◽  
Complete Blood Cell Count ◽  
Blood Cell Count ◽  
Thrombocytopenic Purpura ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening

The clinical presentation of myelodysplastic syndrome (MDS) is not specific. Many patients can be asymptomatic and can be detected only due to an abnormal complete blood cell count (CBC) on routine exam or for other reasons while others can be symptomatic as a consequence of underlying cytopenias. Thrombotic thrombocytopenic purpura (TTP) usually is suspected under the evidence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia and because it is a life-threatening condition (medical emergency) immediate initiation of plasmapheresis could be life-saving. The following case illustrates an unusual presentation of MDS in a patient who came in to the emergency room with the classic TTP “pentad” of fever, renal involvement, MAHA, mental status changes, and thrombocytopenia. We will focus our discussion in the clinical presentation of this case.

scholarly journals An investigation into the avoidability of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mohammed Ibn-Mas’ud Danjuma ◽  
Lina Mohammad Ahmad Naseralallah ◽  
Bodoor AbouJabal ◽  
Mouhand Faisal Mohamed ◽  
Ibrahim Y. Abubeker ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Clinical Presentation ◽  
Intraclass Correlation ◽  
Significant Proportion ◽  
Dress Syndrome ◽  
Study Population ◽  
The Mean ◽  
Systemic Symptoms ◽  
Larger Sample

AbstractDrug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rising morbidity amongst hospitalized patients. Whilst clinical protocols for the management of individual DRESS cases have been well established, determination of potential prevention of these cases by utilizing novel “avoidability” tools has remained unexplored. This retrospective study reviewed records of patients who presented to the emergency department of Weill Cornell Medicine-affiliated Hamad General Hospital, Doha Qatar with suspected DRESS syndrome. These cases were independently adjudicated (utilizing the RegiSCAR, and JSCAR tools) as DRESS-drug pairs by a team of two clinical pharmacists and two General Physicians. They were then rated for potential avoidability with the Liverpool adverse drug reactions avoidability tool (LAAT) by the same team of raters. A total of 16 patients satisfied RegiSCAR criteria for DRESS syndrome. The mean age of the study population was 41.5 years (SD ± 13.3). The study population was predominantly male (n = 12; [75%]). The median latent period from drug ingestion to clinical presentation was 14 days (interquartile range [IQR] 6.5, 29). The median RegiSCAR and J-SCAR scores were 6 (IQR 5, 6.8), 5 (IQR 4, 5.8) respectively. Utilizing the LAAT, about 60% of the DRESS syndrome-drug pairs were rated as “avoidable” (“probable” or “definite”). The overall Krippendorf’s alpha with the LAAT was 0.81 (SE 0.10, CI 0.59–1.00); with an intraclass correlation coefficient (ICC) of 0.90 (CI 0.77, 0.96.). In a randomly selected cohort of DRESS syndrome-drug pairs, a significant proportion was potentially avoidable (“possibly” and “definitely”) utilizing the LAAT. This will need validation by larger sample-sized prospective studies utilizing the updated LAAT proposed by this study.

scholarly journals Acute ileocolitis as a presentation of Sars Cov-2 infection in children- A case report

2021 ◽  
Vol 7 (4) ◽  
pp. 218-220
Author(s):  
Raghavendra H Gobbur ◽  
Ranjima M Mahesh
Keyword(s):  
Clinical Presentation ◽  
Acute Liver Injury ◽  
Kidney Injury ◽  
Symptomatic Infection ◽  
Pain Abdomen ◽  
Asymptomatic Children ◽  
Threatening Condition ◽  
Life Threatening ◽  
Inflammatory Syndrome ◽  
The Impact

As COVID-19 continues to spread in India and other countries, the impact of the disease among children, initially considered less important, is becoming more relevant. The extent of the diversity of clinical presentation of COVID-19 in children are still unclear. We have already seen a new clinical picture of SARS-CoV-2 in children manifesting as a hyper-inflammatory syndrome, with multi-organ involvement similar to Kawasaki Disease and with potential evolution to a shock syndrome. This represented a new phenomenon affecting previously asymptomatic children with SARS-CoV-2 infection. COVID-19 may also manifest as viral hepatitis, acute pancreatitis, acute liver injury, acute kidney injury, ARDS, Sepsis, septic shock and meningo-encephalitis and cerebellar ataxia. The Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection occurs weeks after infection and may evolve unnoticed. MIS-Cs pathophysiology remains unclear. However, it appears to be a postinfectious hyperimmune response that may occur during or following asymptomatic or symptomatic infection. COVID-19 infection in children may lead to a potentially life threatening condition that we may not be aware of. We are in need of reporting of the diverse presentation of SARS CoV-2 virus in children. Here we describe a case of a previously normal 14-year-old boy who manifested with severe pain abdomen after SARS CoV-2 infection and was diagnosed as Acute Ileocolitis secondary to COVID-19. Child improved with steroid therapy and was asymptomatic after 3 weeks of treatment.

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