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

Abstract Purpose Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rising morbidity amongst hospitalized patients. Significant uncertainty remains regarding its exact diagnostic tool. Whilst algorithms for management of index cases have been well established, examination of its potential preventability by utilizing novel “avoidability” tools have remained unexplored.Methods This prospective study is comprised of patients who presented to emergency department of Weill Cornell Medicine-affiliated Hamad General Hospital, Doha Qatar with suspected DRESS syndrome. These cases were comparatively adjudicated and ascertained independently using RegiSCAR, and JSCAR tools by two clinical pharmacists and two General Physicians. They were subsequently rated for potential avoidability utilizing the Liverpool adverse drug reactions avoidability tool (LAAT) by the same team of raters.Results A total of 16 patients satisfy RegiSCAR criteria for DRESS syndrome. The mean age of the study population was 41.5 (SD ± 13.3) years, with a disproportionately male phenotype (n = 12; [75%]). The median latent period from drug ingestion to clinical presentation was 14 days (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 tool, 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.).Conclusion In a randomly selected cohort of DRESS syndrome-drug pairs, the LAAT tool showed a significant proportion that were potentially avoidable (“possibly” and “definitely”). This will need validation by large sample sized prospective studies utilizing the updated LAAT tool proposed by this study.

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

Scientific Reports ◽

10.1038/s41598-021-97381-6 ◽

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.

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An Uncommon Presentation of DRESS Syndrome Secondary to Leflunomide Use: A Case Report

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709621997282 ◽

2021 ◽

Vol 9 ◽

pp. 232470962199728

Author(s):

Suman Rao ◽

Akhila Sunkara ◽

Nimisha Srivastava ◽

Parth Sampat ◽

Christopher Ramos ◽

...

Keyword(s):

Drug Reaction ◽

Inflammatory Markers ◽

Clinical Presentation ◽

Organ Damage ◽

Lymph Node Biopsy ◽

Dress Syndrome ◽

Node Biopsy ◽

Uncommon Presentation ◽

Systemic Symptoms ◽

Rule Out

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a constellation of symptoms that manifest as a result of certain medications. Several antipsychotics, antibiotics, and sulfa-containing drugs are known to be implicated in the etiology of DRESS syndrome. The clinical presentation of this disorder consists of a diffuse rash, lymphadenopathy, and systemic organ damage. Our patient presented with symptoms consistent with DRESS syndrome after being started on leflunomide, which is not commonly associated with DRESS. The diagnostic workup comprised of monitoring inflammatory markers on laboratory work, an excisional lymph node biopsy (to rule out malignancy), and a skin biopsy (to assess the etiology of the rash). Our patient received systemic steroids, dose-adjusted based on expert opinion. Further research is required to explore the association between leflunomide and DRESS and address guidelines for the management of DRESS.

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Hepatic manifestations of drug reaction with eosinophilia and systemic symptoms syndrome

Exploration of Medicine ◽

10.37349/emed.2021.00037 ◽

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.

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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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