scholarly journals Co-Trimoxazole Induced Severe Cutaneous Adverse Reaction: A Challenging Diagnosis

2020 ◽  
Vol 10 (5-s) ◽  
pp. 191-194
Author(s):  
M Sreehari ◽  
M M Sana ◽  
Cyril Tom
Keyword(s):  
Drug Reaction ◽  
Latency Period ◽  
Late Presentation ◽  
Dress Syndrome ◽  
Exfoliative Dermatitis ◽  
Culprit Drug ◽  
Symptomatic Management ◽  
Elevated Liver Enzymes ◽  
Systemic Symptoms ◽  
Immunodeficiency Syndrome

Introduction; Drug Reaction with Eosinophilia and systemic symptoms (DRESS) Syndrome is a life-threatening reaction with a mortality rate of 10-20%. Usual reaction period is 2 to 6 week after the first intake of drug. The present case is an example of late presentation of the symptoms which made the diagnosis difficult. Clinical case: We describe a case of 51 year old male with known history of Acquired ImmunoDeficiency Syndrome (AIDS) and Tuberculosis (TB) presented with complaints of fever, generalised scaling, oedema, eosinophilia and elevated liver enzymes. The symptoms started 45 days back but was then misdiagnosed and treated as exfoliative dermatitis from a local hospital. The symptoms aggravated since 5 days and were admitted in our hospital. Drug reaction was least suspected as he has been taking the Antiretroviral (ART) and Anti-tubercular (ATT) drugs since 3 to 4 months. But later on culprit drug was identified to be Sulfamethoxazole-Trimethoprim and was soon discontinued. Significant improvement was seen with steroid, antihistamines and other topical agents. Discussion: Timely recognition of DRESS Syndrome, prompt discontinuation of culprit drug and symptomatic management are imperative in a better prognosis. It must also be noted that the latency period can be as long as 105 days after the first intake of the drug, rather than the usual presentation period of 2-6 week.

scholarly journals Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) in an Adolescent Treated With Lamotrigine

2013 ◽  
Vol 18 (3) ◽  
pp. 236-240 ◽  
Author(s):  
Almari Ginory ◽  
Michelle Chaney-Catchpole ◽  
Julie M. Demetree ◽  
Laura M. Mayol Sabatier ◽  
Mathew Nguyen
Keyword(s):  
Drug Reaction ◽  
Stress Disorder ◽  
Liver Enzymes ◽  
Hypersensitivity Syndrome ◽  
Dress Syndrome ◽  
Severe Adverse Reaction ◽  
Elevated Liver Enzymes ◽  
Systemic Symptoms ◽  
Disorder Type ◽  
Caucasian Female

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity syndrome most commonly associated with antiepileptic agents, allopurinol, and sulfonamides. It is a severe adverse reaction associated with fever, rash, eosinophilia, lymphadenopathy, and internal organ involvement. We present the case of a 17-year-old Caucasian female with bipolar disorder type II and posttraumatic stress disorder treated with lamotrigine for a non-Food and Drug Administration-approved indication that developed DRESS syndrome at an initial dose higher than that recommended. Her symptoms were atypical in that she developed a rash with influenza-like symptoms that resolved after discontinuation of lamotrigine and returned 8 days later. She was hospitalized because of elevated liver enzymes and treated with corticosteroids. In patients presenting with rash and systemic symptoms, DRESS syndrome should be considered and treated appropriately to reduce mortality, which can be as high as 10%. Treatment includes withdrawal of the offending agent and corticosteroids.

scholarly journals Drug reaction with eosinophilia and systemic symptom induced by carbamazepine: a case report

2019 ◽  
Vol 8 (5) ◽  
pp. 1115
Author(s):  
Rahul R. Damor ◽  
Amita R. Kubavat ◽  
Kiran G. Piparva
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Antiepileptic Drugs ◽  
Drug Exposure ◽  
Latency Period ◽  
Systemic Symptom ◽  
Dress Syndrome ◽  
Period 2 ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening acute adverse drug reaction (ADR), typically characterized by a long latency period (2-6 weeks to 3 months) from drug exposure. DRESS syndrome is defined by the presence of fever, cutaneous eruption, lymphadenopathy, systemic or asymptomatic internal organ involvement (e.g. Hepatitis, carditis, interstitial nephritis, interstitial pneumonitis, etc.) and haematological abnormalities, mainly leucocytosis, eosinophilia and sometimes atypical lymphocytosis. There are around 50 culprit drugs which cause DRESS syndrome e.g. carbamazepine, phenytoin, allopurinol, sulfa derivatives, antidepressants, antiepileptics, non-steroidal anti-inflammatory drugs and antimicrobials. The incidence of DRESS syndrome has been estimated to be between 1 in 1,000 and 1 in 10,000 drug exposures. There are many reported cases of DRESS syndrome due to carbamazepine, phenytoin, vancomycin, levitiracitam, ceftriaxone etc. Author presented a case of DRESS syndrome by carbamazepin. RegiSCAR and Japanese consensus group have developed specific criteria for making the diagnosis of DRESS syndrome. The patient described here met the majority of criteria according to RegiSCAR scoring guidelines for a diagnosis of DRESS syndrome induced by carbamazepine. As per RegiSCAR diagnostic criteria author had concluded that this was a “Definite” case of DRESS (Drug Reaction with Eosinophilia and Systemic Symptom) syndrome induced by carbamazepine. Carbamazepine is most common broad-spectrum antiepileptic drugs so, this case report will raises awareness among physician to suspect DRESS syndrome in patients who present unusual complaints and skin findings after starting antiepileptic drugs.

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 Pulmonary Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Pahnwat Tonya Taweesedt ◽  
Charles W. Nordstrom ◽  
Jessica Stoeckel ◽  
Igor Dumic
Keyword(s):  
Systematic Review ◽  
Drug Reaction ◽  
Acute Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Latency Period ◽  
Lung Involvement ◽  
Dress Syndrome ◽  
Pulmonary Manifestations ◽  
Life Threatening ◽  
Systemic Symptoms

Background. The syndrome of drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, yet potentially fatal hypersensitivity reaction, most commonly associated with anticonvulsants, sulfonamides, and allopurinol. The reaction commonly manifests as a febrile skin eruption with lymphadenopathy and malaise between two and eight weeks following drug exposure. Internal organ involvement occurs in close to 90 percent of patients, and multiple organs may be involved in approximately half of those affected (most commonly the liver, kidney, and lung). Its long latency period and its variable clinical pattern of presentation have earned it the moniker of “the great mimicker,” with delays in diagnosis leading to higher morbidity and mortality. Although less commonly affected in DRESS syndrome, lung involvement is associated with more severe clinical course and potentially worse outcome. Pulmonary symptoms may precede development of the other more common symptoms and signs of the syndrome, or they might develop later in the course of the disease. Lung involvement in DRESS presents with a plethora of manifestations from mild cough or dyspnea with nonspecific interstitial changes on chest imaging to acute respiratory distress syndrome (ARDS) with life-threatening hypoxic respiratory failure. Methods. We performed a systematic review of literature from the PubMed database and selected cases of definite DRESS syndrome as defined by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) with a score of 6 or more who also had pulmonary involvement. Demographic data, pattern of lung involvement, culprit medication, latency period, laboratory findings, therapy, and outcome were described and compared with the literature. Results. The most common pulmonary radiographic findings in DRESS were interstitial infiltrates in 50% of cases, followed by acute respiratory distress syndrome (ARDS) 31%. Symptoms of cough and shortness of breath (SOB) were present in 72% of patients at the time of presentation. SOB was the more common presenting symptom (81%) compared to cough (19%). In 95% of cases, another visceral organ was involved (most commonly liver or kidneys). 45% of cases were initially misdiagnosed as pneumonia and were treated with empiric antimicrobials. In a multivariate regression, a latency of 30 days or less and an age of 60 or less were associated with development of ARDS. Gender and eosinophil count were not associated with severity of pulmonary manifestations. All patients recovered, and in the vast majority of cases (95%), parenteral steroids were used for treatment in addition to supportive care and symptomatic management. Conclusion. Albeit rare, DRESS is a potentially life-threatening syndrome which may present with a myriad of pulmonary signs and symptoms. Pulmonary manifestations are less common but are typically seen in more severe cases. Pulmonary manifestations may be a presenting sign of DRESS, and timely recognition is important in order to stop offending medication and decrease morbidity and mortality.

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,

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 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.

scholarly journals Raltegravir-associated Drug-Reaction With Eosinophilia and Systemic Symptoms Syndrome in a Pediatric Patient Without Characteristic Human Leukocyte Antigen B*57:01 or B*53:01 alleles

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.

scholarly journals Erosive cheilitis as an early manifestation in DRESS syndrome

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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