Unravelling cases of clozapine-related Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in patients reported otherwise: A systematic review

2021 ◽  
pp. 026988112110215
Author(s):  
Renato de Filippis ◽  
Pau Soldevila-Matías ◽  
Daniel Guinart ◽  
Pasquale De Fazio ◽  
Jose M Rubio ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Clinical Manifestations ◽  
Dress Syndrome ◽  
Drug Induced ◽  
Clinical Variables ◽  
Registration Number ◽  
Review Reports ◽  
Systemic Symptoms ◽  
Meta Analyses ◽  
Demographic Patterns

Background: The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity reaction. Aims: Aim was to review reports of clozapine-related reactions fulfilling the registry of severe cutaneous adverse reaction (RegiSCAR) criteria for DRESS syndrome reported as such or otherwise, to provide a descriptive overview of demographic patterns, clinical manifestations, and DRESS course and investigate associations between demographic, DRESS parameters, and clinical outcomes. Methods: This review was conducted following preferred reporting items for systematic reviews and meta-analyses guidelines and registered with PROSPERO (registration number CRD42020156385). We searched PubMed/Embase/PsychInfo/Cochrane for reports of clozapine-related reactions meeting RegiSCAR criteria. Associations between RegiSCAR scores and time-to-recovery with demographic/clinical variables were assessed. Demographic/clinical characteristics of patients with versus without reported DRESS were compared using non-parametrical tests. Results: We identified 26 reports of 27 patients meeting RegiSCAR criteria. Males ( n = 19, 70.4%) and patients with schizophrenia ( n = 18, 66.7%) were mainly affected. Twelve patients (44.4%) received clozapine-monotherapy. DRESS symptoms manifested within a month after clozapine initiation ( n = 24, 88.9%). Lungs and liver were the most common organs involved ( n = 12, 44.4%; n = 11, 40.7%), with a mean time to recovery of 33.75 days. Clozapine rechallenge led to DRESS recurrence in four patients. Death rate was 7.4%. No associations were detected between RegiSCAR criteria or days to recovery with any demographic/clinical variables. No differences between patients with versus without reported DRESS were detected. Conclusions: Clozapine-related DRESS may be rare, but also underreported. Clinicians need to be aware of it even in patients under clozapine-monotherapy or without skin rash.

scholarly journals Drug Reaction with Eosinophilia and Systemic Symptoms: A Complex Interplay between Drug, T Cells, and Herpesviridae

2021 ◽  
Vol 22 (3) ◽  
pp. 1127
Author(s):  
Luckshman Ganeshanandan ◽  
Michaela Lucas
Keyword(s):  
Drug Reaction ◽  
Human Leukocyte ◽  
Molecular Techniques ◽  
Dress Syndrome ◽  
Complex Interplay ◽  
Drug Induced ◽  
Leukocyte Antigen ◽  
Systemic Symptoms ◽  
Delayed Hypersensitivity Reaction

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, also known as drug induced hypersensitivity (DiHS) syndrome is a severe delayed hypersensitivity reaction with potentially fatal consequences. Whilst recognised as T cell-mediated, our understanding of the immunopathogenesis of this syndrome remains incomplete. Here, we discuss models of DRESS, including the role of human leukocyte antigen (HLA) and how observations derived from new molecular techniques adopted in key studies have informed our mechanism-based understanding of the central role of Herpesviridae reactivation and heterologous immunity in these disorders.

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 Cephalosporin-Induced Atypical DRESS Syndrome; a Tale of Two Cases

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Ravindranath Brahmadeo Chavan ◽  
Vasudha Abhijit Belgaumkar ◽  
Nitika S. Deshmukh ◽  
Amruta Patil ◽  
Vijay Deepak Joshi
Keyword(s):  
Drug Reaction ◽  
Adverse Reactions ◽  
Stevens Johnson Syndrome ◽  
Standard Group ◽  
Erythematous Rash ◽  
Dress Syndrome ◽  
Drug Induced ◽  
Severe Cutaneous Adverse Reactions ◽  
Systemic Symptoms ◽  
Cutaneous Adverse Reactions

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, idiosyncratic subset of drug-induced hypersensitivity syndrome manifesting as skin eruption, fever, lymphadenopathy, hematologic abnormalities, and multi-organ involvement. It presents usually after a latent period of 2 to 6 weeks as a diffuse erythematous rash with systemic symptoms and facial edema. It is now recognized as one of the severe cutaneous adverse reactions (SCAR) associated with high mortality, chiefly because of derangement of renal or liver functions. The cutaneous morphologies can be myriad, encompassing maculopapular, exfoliative dermatitis-like, pustular, erythema multiforme-like, Stevens-Johnson syndrome-like, and toxic epidermal necrolysis-like presentations. Case Presentation: We hereby report two young males who developed pruritic exfoliating erythematous rash after taking cephalosporin with paradoxical worsening despite drug withdrawal. They were diagnosed with ‘atypical DRESS syndrome’ according to the Japanese study group severe cutaneous adverse reactions (J-SCAR) criteria and treated successfully with systemic steroids and emollients. The J-SCAR scoring and the concept of atypical DRESS are useful in situations, where either all clinical and laboratory criteria are not present simultaneously, or typical clinical presentations wherein human herpes virus-6 (HHV-6) reactivation cannot be documented. Conclusions: These two cases were used to illustrate the hitherto obscure concept of atypical DRESS syndrome that presented with compatible clinical features but did not satisfy all the requisite criteria. We also highlight cephalosporins (one of the most commonly prescribed standard group of drugs) as a plausible but infrequently reported cause of this severe adverse cutaneous drug reaction.

scholarly journals ATT-Therapy Induced DRESS: A Case Report

2021 ◽  
Vol 11 (5-S) ◽  
pp. 1-5
Author(s):  
Navya Sri G ◽  
Feba Stanly ◽  
Georgina Sarah ◽  
Prasad Bali ◽  
Varsha Dalal
Keyword(s):  
Drug Reaction ◽  
Clinical Symptoms ◽  
Latency Period ◽  
Hypersensitivity Syndrome ◽  
The Body ◽  
Dress Syndrome ◽  
Tubercular Meningitis ◽  
Drug Induced ◽  
Systemic Symptoms ◽  
Anti Tubercular Therapy

A severe adverse reaction called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS syndrome), is usually described by eosinophilia, fever, swollen lymph nodes, severe skin rash and extensive systemic association. It is distinguished by a lengthy latency period, which is characteristic drug reaction with eosinophilia and systemic symptoms (DRESS). Formerly known as drug-induced delayed multi-organ hypersensitivity syndrome (DIDMOHS) or drug-induced hypersensitivity (DIHS). There are a variety of clinical symptoms associated with the syndrome yet it is still poorly understood. Drugs most commonly implicate in Anticonvulsants are the most common cause of DRESS syndrome, followed by sulfonamides and a variety of anti-inflammatory medications.Anti-tubercular therapy (ATT) is rarely associated with DRESS syndromeWe present the case of a 60-year-old female patient who had previously been treated with Anti-tubercular Therapy for Tubercular Meningitis (ATT).She was admitted to the hospital with presenting complaints of vomiting, burning micturition, fever associated with chills, generalized swelling and reddish skin all over the body including facial puffiness. The problem was successfully resolved by refraining from the offending medication and administering supportive care. Thus, the case illustrates the necessity of considering anti-tubercular drug reactions even when symptoms are delayed. Keywords: Anti-tubercular Therapy (ATT), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Adverse drug reaction (ADR), Drug-induced, Systemic symptoms syndrome,

scholarly journals The drug-induced pulmonary eosinophilia

2011 ◽  
Vol 8 (4) ◽  
pp. 15-22
Author(s):  
Boris Anatol'evich Chernyak ◽  
I I Vorzheva ◽  
B A Chernyak ◽  
I I Vorzheva
Keyword(s):  
Drug Reaction ◽  
Diagnostic Criteria ◽  
Clinical Features ◽  
Component Part ◽  
Pulmonary Eosinophilia ◽  
Dress Syndrome ◽  
Drug Induced ◽  
Medical Products ◽  
Clinical Variant ◽  
Systemic Symptoms

in the review modern data on drug-induced pulmonary eosinophilia - heterogeneous group of the diseases proceeding separately (syndrome lÖffler, acute and chronic eosinophilic pneumonias), or as the component part of a DRESS-syndrome (drug reaction with eosinophilia and systemic symptoms) is introduced. The list of the medical products most often causing development of pulmonary eosinophilia is presented. clinical features of simple pulmonary eosinophilia, acute and chronic eosinophilia pneumonias, a DRESS-syndrome are described. Diagnostic criteria and principles of therapy of pulmonary eosinophilia depending on a clinical variant are reviewed.

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. 

scholarly journals Antiviral Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Dyndrome: A Literature Review

2020 ◽  
Author(s):  
Shiva Sharifzadeh ◽  
Sepideh Elyasi ◽  
Amir Hooshang Mohammadpour
Keyword(s):  
Drug Reaction ◽  
Antiviral Agents ◽  
Latency Period ◽  
Organ Damage ◽  
Viral Reactivation ◽  
Dress Syndrome ◽  
Drug Induced ◽  
Hepatic Involvement ◽  
Systemic Corticosteroids ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) is a delayed infrequent potentially life-threatening drug reaction. Fever, rash, lymphadenopathy, eosinophilia, and hepatic involvement are common features. Aromatic anticonvulsants and allopurinol are the most frequent causative agents. However, some cases of antivirals induced DRESS are available. In this review, we try to summarize studies of antiviral induced DRESS syndrome.  The data were collected by searching PubMed, Science Direct, Google Scholar, Scopus, Cochrane database systematic reviews, and Islamic World Science Citation Center (ISC). The Keywords used as search terms were “DRESS syndrome”, “drug-induced hypersensitivity reaction (DIHS)”, “antiviral”, and names of various antiviral agents. Finally, a total of 28 relevant articles up to the date of publication were included for review. Totally, 30 cases of antiviral induced DRESS are reported. European registry on severe cutaneous adverse drug reactions (RegiSCAR) was the usual used clinical diagnostic criteria. Most of the reports were related to, telaprevir. Rash and fever actually occurred in a large number of these patients. Eosinophilia was the most reported hematologic involvement. Liver injury is the most defined type of organ damage. Most of the patients managed with systemic corticosteroids. The death occurred in 1 patient from liver decompensation. The reactivation various viruses especially HHV-6 is reported in 2 Cases. The latency period was between 10 and 330 days after drug administration. It is necessary to perform more studies, especially those focused on the association between DRESS syndrome and viral reactivation and also its effective management. J Pharm Care 2020; 8(1): 35-47.

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