C-Reactive Protein and Procalcitonin in Case Reports of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome

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.

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DRESS syndrome (drug rash with eosinophilia and systemic symptoms): sometimes, not all signs are there

Italian Journal of Medicine ◽

10.4081/itjm.2021.1475 ◽

2021 ◽

Vol 15 (3) ◽

Author(s):

Fábio Murteira ◽

Pedro Oliveira ◽

João Miranda ◽

Albina Moreira ◽

Margarida Correira

Keyword(s):

Skin Biopsy ◽

Late Onset ◽

Skin Lesions ◽

Skin Tone ◽

C Reactive Protein ◽

Dress Syndrome ◽

Reactive Protein ◽

Drug Rash ◽

Systemic Symptoms ◽

Elevated Transaminases

DRESS syndrome is a rare and potentially fatal multisystemic reaction that occurs two to six weeks after exposure to certain drugs. It is characterized by fever, eosinophilia, and skin rash. Case of a 37-year-old man, black, with gout (started allopurinol 4 weeks before). He arrived at the Emergency Room complaining of headache, fever, abdominal pain, and scattered maculopapular skin lesions. The conducted study showed elevated transaminases and C-reactive protein, hepatomegaly, and peri-hepatic adenomegalies. Allopurinol was stopped, but throughout hospitalization, liver, renal and neurological dysfunctions (with meningoencephalitis) worsened; it also appeared eosinophilia. A skin biopsy was performed, the possibility of DRESS syndrome was assumed, and methylprednisolone 2 mg/kg/day was started, with progressive improvement. The skin biopsy was compatible with DRESS. The described case reveals some peculiarities. Among the most relevant arethe late onset of eosinophilia and the difficulty in evaluating the rash due to the patient's skin tone and neurological manifestations (rare).

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Raltegravir-associated Drug-Reaction With Eosinophilia and Systemic Symptoms Syndrome in a Pediatric Patient Without Characteristic Human Leukocyte Antigen B57:01 or B53:01 alleles

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa089 ◽

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.

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Levetiracetam-Associated Acute Kidney Injury and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome

Open Journal of Nephrology ◽

10.4236/ojneph.2014.44022 ◽

2014 ◽

Vol 04 (04) ◽

pp. 152-155 ◽

Cited By ~ 1

Author(s):

Mathieu Leblanc ◽

Martin Plaisance

Keyword(s):

Acute Kidney Injury ◽

Drug Reaction ◽

Kidney Injury ◽

Dress Syndrome ◽

Systemic Symptoms

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Erosive cheilitis as an early manifestation in DRESS syndrome

10.22541/au.163421953.33548422/v1 ◽

2021 ◽

Author(s):

wahbi ben salha ◽

eya moussaoui ◽

lamia oualha ◽

Jihed Anoun ◽

Nabiha Douki

Keyword(s):

Uric Acid ◽

Drug Reaction ◽

Adverse Reactions ◽

Dress Syndrome ◽

Mucosal Involvement ◽

Severe Cutaneous Adverse Reactions ◽

Lowering Drug ◽

Systemic Symptoms ◽

Cutaneous Adverse Reactions ◽

Early Manifestation

Drug reaction with eosinophilia and systemic symptoms (DRESS) is part of Severe cutaneous adverse reactions. Allopurinol, an uric acid-lowering drug, had been incriminated in several cases of Allopurinol-induced Dress syndrome.Through this paper, we present a case of Allopurinol-induced DRESS syndrome with initial oral mucosal involvement.

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