scholarly journals Case Reports of DRESS Syndrome and Symptoms Consistent with DRESS Syndrome Following Treatment with Recently Marketed Monoclonal Antibodies

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
James C. Di Palma-Grisi ◽  
Kesav Vijayagopal ◽  
Muhammad A. Muslimani
Keyword(s):  
Monoclonal Antibodies ◽  
Case Reports ◽  
Maculopapular Rash ◽  
Phase Iii ◽  
Dress Syndrome ◽  
Drug Induced ◽  
Diagnostic Reliability ◽  
Phase Iii Clinical Trials ◽  
Life Threatening ◽  
Systemic Symptoms

Background. Monoclonal antibodies constitute a potent and broadly tolerable drug class, representing for some conditions the first newly approved treatment in years. As such, many are afforded “fast-track” or “breakthrough therapy” designations by the U.S. Food and Drug Administration, leading to provisional approval before Phase III clinical trials are reported. Although these drugs are usually safe, some patients experience life-threatening complications—myositis and encephalitis have led to permanent or temporary recalls. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity condition easily missed due to its long incubation period and nonspecific presentation. This minireview is primarily intended as an abbreviated guide for practitioners who may be using these powerful treatments. Methodology. We searched PubMed using a string of symptoms consistent with DRESS syndrome and monoclonal antibodies approved by the FDA since 2015. Then, we excluded studies reporting dermatological complications of reactivation of nonherpetic infection, immunodeficiency-related infection, or reactions to the injection site or infusion. We searched for and accessed prior reviews and background studies via PubMed, Mendeley, and Google Scholar. Results. Two cases of DRESS syndrome were identified in the literature, both the result of treatment with daclizumab. There was one additional case of encephalitis without cutaneous symptoms caused by daclizumab. Drug-induced hypersensitivity dermatitis was reported following treatment with nivolumab and two cases of combination treatment with ipilimumab and either nivolumab or durvalumab produced maculopapular rash and bullae in the first patient and lichenoid dermatitis and blisters in the second patient. Conclusions. Daclizumab was the only recently approved monoclonal antibody associated with DRESS syndrome as such. Limitations in the diagnostic reliability of DRESS syndrome as a clinical entity and the lack of negative clinical trial reporting suggest enhanced vigilance on the part of clinicians and regulators may be warranted.

scholarly journals Successful Treatment of Antiepileptic Drug-Induced DRESS Syndrome with Pulse Methylprednisolone

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Celebi Kocaoglu ◽  
Ceyda Cilasun ◽  
Ece Selma Solak ◽  
Gulcan S. Kurtipek ◽  
Sukru Arslan
Keyword(s):  
Valproic Acid ◽  
Present Report ◽  
Treatment Modalities ◽  
Dress Syndrome ◽  
Internal Organs ◽  
Drug Induced ◽  
Pulse Methylprednisolone ◽  
Lymph Node Enlargement ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially life-threatening syndrome characterized by skin rash, fever, lymph node enlargement, and involvement of internal organs. It is most commonly induced by aromatic anticonvulsants and antibiotics. Nonaromatic anticonvulsants are rarely encountered as the causes of DRESS syndrome. In the present report, three discrete cases with DRESS syndrome developing due to three antiepileptic drugs, including valproic acid (nonaromatic), carbamazepine (aromatic), and lamotrigine (aromatic), and their treatment modalities were aimed to be discussed in light of the literature. To the best of our knowledge, our cases are the first children to be treated with pulse methylprednisolone in the literature.

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 rash with eosinophilia and systemic symptoms, uncommon and commonly missed

2019 ◽  
Vol 6 (4) ◽  
pp. 1360
Author(s):  
Dona Das ◽  
Dinesh E. Ragav ◽  
A. Nasreen Begum
Keyword(s):  
Hypersensitivity Reaction ◽  
Blood Count ◽  
Dress Syndrome ◽  
Rare Form ◽  
Drug Induced ◽  
Life Threatening ◽  
Rapid Pace ◽  
Drug Rash ◽  
Systemic Symptoms ◽  
Kidney Liver

Drug Rash with eosinophilia and systemic symptoms, also called DRESS syndrome, is a rare form of drug induced hypersensitivity reaction that presents with skin eruptions, blood count abnormalities (eosinophilia) and internal organ involvement (lung, kidney, liver), making it life threatening at a rapid pace. The most commonly affected organ is liver, mimicking condition similar to acute hepatitis.

scholarly journals A probable case of sodium valproate monotherapy induced drug reaction with eosinophilia and systemic symptoms syndrome: a case report in Indian population

2020 ◽  
Vol 9 (6) ◽  
pp. 991
Author(s):  
Vijayamathy Arunnair ◽  
Girish Kumaraswamy ◽  
Ramesh M.
Keyword(s):  
Drug Reaction ◽  
Bipolar Disorders ◽  
Maculopapular Rash ◽  
Hypersensitivity Syndrome ◽  
Dress Syndrome ◽  
Drug Induced ◽  
Probable Case ◽  
History Of ◽  
Systemic Symptoms ◽  
Generalized Lymphadenopathy

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity syndrome most commonly caused by anti-epileptics like carbamazepine, phenytoin. It usually manifests as maculopapular rash, fever, eosinophilia, generalized lymphadenopathy, hepatitis, atypical lymphocytosis, and leucocytosis with the involvement of other organs. Valproate, a broad-spectrum antiepileptic, also used in bipolar disorders and migraine prophylaxis, is generally well tolerated. To date, very few cases of valproate monotherapy induced DRESS syndrome have been reported worldwide and here we are reporting one such rare case in a 72 years old Indian woman with a history of generalised tonic convulsions. The patient was classified as a ‘probable’ case of DRESS syndrome using the WHO-UMC criteria and Naranjo scale. Discontinuation of the offending medication and treatment with intravenous (IV) fluids, antihistamines, and steroids helped in recovery of the patient. Healthcare practitioners must be aware of valproate monotherapy induced DRESS syndrome and take effective measures to avoid severe side effects. 

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Induced by Imatinib

2019 ◽  
Vol 14 (2) ◽  
pp. 151-154 ◽  
Author(s):  
F. Zgolli ◽  
I. Aouinti ◽  
O. Charfi ◽  
T. Badri ◽  
S. Elaidli ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Liver Function Tests ◽  
Exceptional Case ◽  
Favourable Outcome ◽  
Dress Syndrome ◽  
Drug Induced ◽  
Life Threatening ◽  
Drug Rash ◽  
Systemic Symptoms ◽  
European Registry

Introduction: Imatinib is the treatment of choice in patients with locally advanced or metastatic gastrointestinal stromal tumours (GIST). Clinical tolerance of imatinib is excellent except for the common adverse drug reaction (ADR). Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a severe, potentially life-threatening drug-induced hypersensitivity reaction, characterized by cutaneous eruptions, fever, diffuse lymphadenopathy, along with eosinophilia, and elevated liver function tests. This ADR is rarely reported with imatinib. Only four cases of DRESS syndrome associated with imatinib have already been published. Case Report:We report an exceptional case of DRESS syndrome associated with imatinib in a 46 year-old woman with GIST. Two weeks after she had started imatinib therapy, she developed a skin rash, with eosinophilia and elevated liver tests. Plasma level of imatinib was within the therapeutic range. Imatinib was immediately discontinued. A favourable outcome was slowly observed after the drug had been stopped. Results and Conclusion: This case was scored three according to the European Registry of Severe Cutaneous Adverse Reactions Study Group (RegiSCAR). The Naranjo score for imatinib was five (probable).

scholarly journals Clinical spectrum and severity of hemolytic anemia in glucose 6-phosphate dehydrogenase–deficient children receiving dapsone

Blood ◽  
2012 ◽  
Vol 120 (20) ◽  
pp. 4123-4133 ◽  
Author(s):  
Allan Pamba ◽  
Naomi D. Richardson ◽  
Nick Carter ◽  
Stephan Duparc ◽  
Zul Premji ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hemolytic Anemia ◽  
G6pd Deficiency ◽  
Case Reports ◽  
Drug Induced ◽  
Once Daily ◽  
Maximum Decrease ◽  
Life Threatening ◽  
The Mean ◽  
Glucose 6 Phosphate Dehydrogenase

AbstractDrug-induced acute hemolytic anemia led to the discovery of G6PD deficiency. However, most clinical data are from isolated case reports. In 2 clinical trials of antimalarial preparations containing dapsone (4,4′-diaminodiphenylsulfone; 2.5 mg/kg once daily for 3 days), 95 G6PD-deficient hemizygous boys, 24 G6PD-deficient homozygous girls, and 200 girls heterozygous for G6PD deficiency received this agent. In the first 2 groups, there was a maximum decrease in hemoglobin averaging −2.64 g/dL (range −6.70 to +0.30 g/dL), which was significantly greater than for the comparator group receiving artemether-lumefantrine (adjusted difference −1.46 g/dL; 95% confidence interval −1.76, −1.15). Hemoglobin concentrations were decreased by ≥ 40% versus pretreatment in 24/119 (20.2%) of the G6PD-deficient children; 13/119 (10.9%) required blood transfusion. In the heterozygous girls, the mean maximum decrease in hemoglobin was −1.83 g/dL (range +0.90 to −5.20 g/dL); 1 in 200 (0.5%) required blood transfusion. All children eventually recovered. All the G6PD-deficient children had the G6PD A− variant, ie, mutations V68M and N126D. Drug-induced acute hemolytic anemia in G6PD A− subjects can be life-threatening, depending on the nature and dosage of the drug trigger. Therefore, contrary to current perception, in clinical terms the A− type of G6PD deficiency cannot be regarded as mild. This study is registered at http://www.clinicaltrials.gov as NCT00344006 and NCT00371735.

scholarly journals Dress Syndrome - A Case Report

2016 ◽  
Vol 8 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Zorana Kremić ◽  
Željko P. Mijušković ◽  
Lidija Kandolf-Sekulović
Keyword(s):  
Supportive Therapy ◽  
Dress Syndrome ◽  
Drug Induced ◽  
Systemic Manifestations ◽  
Inflammatory Drugs ◽  
Hematological Abnormalities ◽  
Systemic Symptoms ◽  
Generalized Epilepsy ◽  
Maculopapular Exanthema ◽  
Induced Reaction

Abstract The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse drug-induced reaction that occurs most commonly after exposure to drugs, most frequently anticonvulsants, sulfa derivates, antidepressants, nonsteroidal anti-inflammatory drugs, and antimicrobials. We present a 61-year-old male, with a generalized maculopapular exanthema on the trunk, face, extremities, palms, soles, palate, and fever (38°C). His medical history was notable for generalized epilepsy, treated with carbamazepine during 1 month. The diagnosis of DRESS syndrome was confirmed by specific RegiSCAR criteria. In our case, skin eruptions were successfully treated with oral methylprednisolone, cephalexin, and topical corticosteroid ointment. In conclusion, although the mechanisms of this syndrome are not completely understood, numerous cases were reported in children and adults. This syndrome should be considered in every patient with skin eruption, fever, eosinophilia, liver and hematological abnormalities. Prompt recognition, supportive therapy and initiation of corticosteroids may prevent systemic manifestations.

scholarly journals Pharmacotherapy of HIV-1 Infection: Focus on CCR5 Antagonist Maraviroc

2009 ◽  
Vol 1 ◽  
pp. CMT.S2365 ◽  
Author(s):  
Olga Latinovic ◽  
Janaki Kuruppu ◽  
Charles Davis ◽  
Nhut Le ◽  
Alonso Heredia
Keyword(s):  
Drug Resistance ◽  
Phase Iii ◽  
Ccr5 Antagonist ◽  
Drug Resistant ◽  
Drug Induced ◽  
Entry Inhibitors ◽  
Phase Iii Clinical Trials ◽  
Infection Focus ◽  
Ccr5 Antagonists ◽  
Hiv 1

Sustained inhibition of HIV-1, the goal of antiretroviral therapy, is often impeded by the emergence of viral drug resistance. For patients infected with HIV-1 resistant to conventional drugs from the viral reverse transcriptase and protease inhibitor classes, the recently approved entry and integration inhibitors effectively suppress HIV-1 and offer additional therapeutic options. Entry inhibitors are particularly attractive because, unlike conventional antiretrovirals, they target HIV-1 extracellularly, thereby sparing cells from both viral- and drug-induced toxicities. The fusion inhibitor enfuvirtide and the CCR5 antagonist maraviroc are the first entry inhibitors licensed for patients with drug-resistant HIV-1, with maraviroc restricted to those infected with CCR5-tropic HIV-1 (R5 HIV-1) only. Vicriviroc (another CCR5 antagonist) is in Phase III clinical trials, whereas the CCR5 antibodies PRO 140 and HGS 004 are in early stages of clinical development. Potent antiviral synergy between maraviroc and CCR5 antibodies, coupled with distinct patterns of resistance, suggest their combinations might be particularly effective in patients. In addition, given that oral administration of maraviroc achieves high drug levels in cervicovaginal fluid, combinations of maraviroc and other CCR5 inhibitors could be effective in preventing HIV-1 transmission. Moreover, since CCR5 antagonists prevent rejection of transplanted organs, maraviroc could both suppress HIV-1 and prolong organ survival for the growing number of HIV-1 patients with kidney or liver failure necessitating organ transplantation. Thus, maraviroc offers an important treatment option for patients with drug-resistant R5 HIV-1, who presently account for >50% of drug-resistance cases.

scholarly journals LAMOTRIGINE INDUCED DRESS SYNDROME

2017 ◽  
Vol 10 (9) ◽  
pp. 3
Author(s):  
Saurab Agarwal ◽  
Balaji Ommurugan ◽  
Amita Priya ◽  
Mohan Amberkar ◽  
Meena Kumari Kamalkishore
Keyword(s):  
Early Detection ◽  
Early Diagnosis ◽  
Hypersensitivity Reaction ◽  
Rare Case ◽  
Dress Syndrome ◽  
Early Recovery ◽  
Life Threatening ◽  
Drug Rash ◽  
Systemic Symptoms ◽  
Life Threatening Event

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, is a type of hypersensitivity reaction, mainly due to anti-epileptic drugs. Lamotrigine is a newer broad spectrum antiepileptic that can be used in both children and adults. Lamotrigine induced DRESS syndrome is a rare case with incidence of 1/1000 to 1/10000. This syndrome manifests as rash, fever, tender lymphadenopathies, hepatitis, and eosinophilia. This case highlights the need for early diagnosis and treatment of such a rare and life threatening event because early detection of the condition leads to early recovery of the patient. Further re-exposure to the drug should be avoided.  

Uncommon Adverse Effects of Deoxycholic Acid Injection for Submental Fullness: Beyond the Clinical Trials

2020 ◽  
Vol 24 (6) ◽  
pp. 619-624
Author(s):  
Kristy C. Metzger ◽  
Erika L. Crowley ◽  
Dorota Kadlubowska ◽  
Melinda J. Gooderham
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Deoxycholic Acid ◽  
Case Reports ◽  
Case Series ◽  
Phase Iii ◽  
Patient Counselling ◽  
Medical Environment ◽  
Phase Iii Clinical Trials ◽  
Health Canada

Deoxycholic acid (BELKYRATM, Allergan, Markham, ON, Canada) is a minimally invasive injectable treatment approved by Health Canada for the nonsurgical reduction of submental fullness. Multiple phase III clinical trials have proven the efficacy and safety of deoxycholic acid. In the clinical trials, the most common adverse events (AEs) reported, such as injection site pain, numbness, swelling, bruising and induration, were transient and mild-to-moderate in severity. Additional postmarketing AEs have been reported in the literature. In this study, we reviewed the uncommon reported events and aimed to increase clinician awareness of the potential adverse effects for patient counselling of risks and benefits, identify AEs of procedures that may be performed outside of the medical environment, and identify factors that increase the risk of an adverse event. Beyond the clinical trials, real-world case reports and case series have been reported for the AEs of alopecia, transient neuropraxia, vascular occlusive events/vascular injury, and skin necrosis. Dermatologists need to be aware of these risks, for the treatment and management of their own patients and for those patients who may be treated outside the medical clinic environment that present for medical management of these AEs.

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