Life-threatening adverse reaction to a commonly used drug (drug reaction with eosinophilia and systemic symptoms syndrome)

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening adverse drug reaction with a mortality rate of 10%. Interstitial nephritis, pneumonitis, myocarditis, meningitis, thyroiditis and pancreatitis are major causes of morbidity and mortality in this syndrome. Cessation of offending medication is paramount. There is paucity in high quality prospective studies guiding the treatment of DRESS, and there are no published therapeutic clinical trials in the treatment of corticosteroid refractory hypersensitivity myocarditis. The authors present a unique case of ciprofloxacin-induced DRESS with concurrent thyroiditis and refractory eosinophilic myocarditis that required mepolizumab and multiple immunosuppressants for successful treatment.

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Successful Phenobarbital Desensitization After DRESS Reaction in the Management of Refractory Status Epilepticus

Journal of Pharmacy Practice ◽

10.1177/0897190018756237 ◽

2018 ◽

Vol 32 (2) ◽

pp. 228-230 ◽

Cited By ~ 3

Author(s):

Robert H. Witcher ◽

Michelle M. Ramirez

Keyword(s):

Drug Reaction ◽

Status Epilepticus ◽

Signs And Symptoms ◽

Punch Biopsy ◽

Refractory Status Epilepticus ◽

Burst Suppression ◽

Refractory Status ◽

Life Threatening ◽

Antiepileptic Medications ◽

Systemic Symptoms

Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with antiepileptic drug use and is a rare but life-threatening side effect. We present a case of phenobarbital-induced DRESS in a patient who subsequently required phenobarbital and was successfully desensitized. Summary: A 5-year-old male presented with medically refractory status epilepticus (SE). He had been trialed on several antiepileptic medications without achieving burst suppression. Burst suppression was achieved with a pentobarbital infusion, and thus, phenobarbital was initiated as the pentobarbital was weaned. After five days of phenobarbital, the patient developed signs and symptoms concerning for DRESS; a punch biopsy confirmed the drug reaction. Two months later, he again developed SE unresponsive to antiepileptic infusions. Burst suppression was achieved with pentobarbital, and it was decided to transition the patient to phenobarbital. Due to concerns of phenobarbital-induced DRESS, the patient underwent a phenobarbital desensitization consisting of 6 doses sequentially administered in 10-fold increasing concentrations before achieving therapeutic dosing. Three days later, the patient achieved therapeutic phenobarbital levels, was weaned off of pentobarbital, and remained seizure-free without recurrence of DRESS. Conclusions: Graded desensitization may be an option to minimize recurrence of DRESS in patients where avoidance of the offending agent is not possible.

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DRESS Syndrome in a Teenage Male Associated With Hhv-6 Reactivation While on Prolonged TMP-SMX Use

10.20944/preprints202103.0054.v1 ◽

2021 ◽

Author(s):

Dalia Conteras ◽

Iris Pecson ◽

Alvaro Galvis

Keyword(s):

Drug Reaction ◽

Healthcare Providers ◽

Delay In Diagnosis ◽

High Clinical Suspicion ◽

Johnson Syndrome ◽

Life Threatening ◽

Steven Johnson Syndrome ◽

Systemic Symptoms ◽

Disseminated Disease ◽

Systemic Drug

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare and potentially life-threatening systemic drug reaction with skin involvement. We present the unusual case of DRESS in a 16-year-old male that was treated with TMP-SMX for acne and was initially misdiagnosed with Steven Johnson Syndrome. Our case serves as an example to healthcare providers treating adverse drug reactions to having a high clinical suspicion for DRESS as delay in diagnosis and treatment can result in disseminated disease and higher patient mortality risk.

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DRESS syndrome: an important differential for eosinophilia with systemic organ dysfunction

BMJ Case Reports ◽

10.1136/bcr-2020-234251 ◽

2020 ◽

Vol 13 (5) ◽

pp. e234251 ◽

Cited By ~ 1

Author(s):

Whoasif Mukit ◽

Richard Cooper ◽

Harmesh Moudgil ◽

Nawaid Ahmad

Keyword(s):

Adverse Drug Reaction ◽

Adverse Reaction ◽

Drug Reaction ◽

Clinical Response ◽

Organ Dysfunction ◽

Patient Harm ◽

Dress Syndrome ◽

Cutaneous Adverse Reaction ◽

Drug Rash ◽

Systemic Symptoms

Drug rash occurring with eosinophilia and systemic symptoms syndrome is a potentially fatal adverse drug reaction that requires immediate action in order to minimise patient harm. Initially implicated with the use of anticonvulsants, it has also been shown to be caused by many other medications but less frequently with vancomycin. Patients typically present with fever, lymphadenopathy, eosinophilia and systemic organ dysfunction. Diagnosis is aided using probability calculators such as RegiSCAR (Registry of Severe Cutaneous Adverse Reaction), as well as clinical response on removing the responsible medication. Here, we present a case without any systemic organ dysfunction that improved with withdrawal of the offending drug vancomycin.

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Phenytoin induced life threatening macroglossia in a child

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.105624 ◽

2013 ◽

Vol 04 (01) ◽

pp. 75-77 ◽

Cited By ~ 3

Author(s):

Rakesh Mondal ◽

Sumantra Sarkar ◽

Tapas Sabui ◽

Partha Pratim Pan

Keyword(s):

Drug Reaction ◽

Hereditary Angioedema ◽

Dress Syndrome ◽

Medical College ◽

Life Threatening ◽

Systemic Symptoms

ABSTRACTIsolated acquired macroglossia of tongue rarely reported. It occurs due to causes like hereditary angioedema, localized angioedema, etc., Here we describe an 8‑year‑old boy developing life threatening localized angioedema of tongue due to phenytoin without any association with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome or pseudolymphoma encountered in rural medical college. Anticonvulsants, that is, phenytoin induced this isolated peculiar complication, which was not described before.

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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A case with adverse reaction to three drugs alternately administered

Journal of Advanced Pediatrics and Child Health ◽

10.29328/journal.japch.1001022 ◽

2021 ◽

Vol 4 (1) ◽

pp. 001-005

Author(s):

Manieri Sergio ◽

Mirauda Maria P ◽

De Gregorio Fabiola ◽

Colangelo Carmela ◽

Tagliente Maria ◽

...

Keyword(s):

Adverse Reaction ◽

Drug Reaction ◽

Case Report ◽

Mortality Rate ◽

Hypersensitivity Reaction ◽

Genetic Predisposition ◽

Intravenous Immunoglobulins ◽

Dress Syndrome ◽

Pediatric Case ◽

Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multiorgan hypersensitivity reaction mostly caused by several eliciting drugs in patients with a genetic predisposition. Incidence of DRESS in children is very variable, frome 1:1000 to 1:10.000, and the mortality rate seems to be lower than 10%. Anti-convulsants are the main drugs involved both in adults and in children. The treatment of choice is the prompt withdrawn of the offending drug and using intravenous immunoglobulins and corticosteroids used in synergy. In recent years, emerging studies have outlined the disease more clearly. We present a pediatric case in which the patient developed DRESS syndrome as a result of exposure to lamotrigine before and carbamazepine after and a relapse after exposure to omeprazole. Starting from this case report we provide an overview on DRESS Syndrome.

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DRESS: a rare adverse drug reaction of olanzapine

Bangladesh Journal of Psychiatry ◽

10.3329/bjpsy.v29i2.37852 ◽

2018 ◽

Vol 29 (2) ◽

pp. 64-66

Author(s):

Mohammad Monirul Islam ◽

Md Azizul Islam ◽

M Kumrul Hasan ◽

Md Abdul Latif Khan

Keyword(s):

Adverse Effect ◽

Drug Reaction ◽

Serum Bilirubin ◽

Rare Complication ◽

Urine Test ◽

Erythematous Rash ◽

The Face ◽

Life Threatening ◽

Assaultive Behavior ◽

Systemic Symptoms

A boy of 17 years was brought by his parents with the complaints of aggressive, violent and assaultive behavior towards parents, using abusive language, demanding money, restlessness, irritability, irrelevant talk and sleep disturbance. His urine test for cannabinoid was positive. He was diagnosed as substance use disorder and was treated with olanzapine along with psychotherapy. After few days, he developed fever followed by erythematous rash with pruritus and swelling of the face, eyelids, trunk and extremities with raised serum bilirubin, ALT and alkaline phosphatase. He was diagnosed as DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), a rare complication of olanzapine. This is a dangerous and life threatening adverse effect. Early diagnosis can reduce its morbidity and mortality.Bang J Psychiatry December 2015; 29(2): 64-66

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Lamotrigine Induced DRESS Syndrome in a Child: A Case Report and Literature Review

Children ◽

10.3390/children8111063 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1063

Author(s):

Chien-Heng Lin ◽

Sheng-Shing Lin ◽

Syuan-Yu Hong ◽

Chieh-Ho Chen ◽

I-Ching Chou

Keyword(s):

Drug Reaction ◽

Case Report ◽

Skin Rash ◽

Stable Condition ◽

Anticonvulsant Drug ◽

Dress Syndrome ◽

Life Threatening ◽

History Of ◽

History Of Epilepsy ◽

Systemic Symptoms

Lamotrigine is an important anticonvulsant drug. Its use, however, has been limited by the risk of potentially life-threatening dermatological reactions, such as a drug reaction with eosinophilia and systemic symptoms (DRESS). Here, we report the case of a 7-year-6-month-old girl with a history of epilepsy who developed a skin rash with dyspnoea after 2 weeks of lamotrigine treatment, with DRESS ultimately being diagnosed. After discontinuation of the offending drug and the initiation of systemic glucocorticosteroids, the DRESS symptoms were relieved and the patient was discharged in a stable condition. Anticonvulsant drugs such as lamotrigine are among the factors that induce DRESS in children. When a patient displays skin rash and systemic organ involvement following the initiation of an anticonvulsant drug, DRESS should not be overlooked as a diagnosis, and immunosuppressant drugs should be considered as an option for treating DRESS patients.

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

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20191610 ◽

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.

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Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide

Hospital Pharmacy ◽

10.1177/0018578717717394 ◽

2017 ◽

Vol 52 (6) ◽

pp. 408-411 ◽

Cited By ~ 5

Author(s):

Anusha Shanbhag ◽

E. Ryan Pritchard ◽

Kshitij Chatterjee ◽

Drayton A. Hammond

Keyword(s):

Drug Reaction ◽

Hemodynamic Instability ◽

African American Female ◽

Probability Scale ◽

Blood Cell Count ◽

Dress Syndrome ◽

Peripheral Smear ◽

Life Threatening ◽

Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening hypersensitivity reaction to medications. We report a case of a 75-year-old African American female who presented with generalized rash with desquamation and malodorous secretions. She was febrile and hypotensive, and required vasopressors for hemodynamic instability. Sepsis secondary to skin or soft tissue infection was considered initially. However, she recently was started on lenalidomide for treatment of her multiple myeloma, and her white blood cell count of 17 K/µL with 55% eosinophils along with peripheral smear showing eosinophilia suggested lenalidomide-induced rash. Lenalidomide was discontinued, and methylprednisolone was initiated. Four days after lenalidomide discontinuation, vasopressors were discontinued. Blood cultures did not exhibit any growth. The Niranjo Adverse Drug Reaction Probability Scale score of 9 suggests lenalidomide was a highly probable cause of DRESS syndrome. The temporal relation of lenalidomide administration and development of symptoms plus improvement of rash with the discontinuation of lenalidomide and reappearance on restarting lenalidomide in the follow-up clinic strengthens our suspicion of lenalidomide-induced DRESS syndrome. Cases of lenalidomide-induced DRESS syndrome are sparse; however, DRESS syndrome is fatal in approximately 10% of patients. Providers should be aware and keep a vigilant eye out for this adverse reaction with lenalidomide.

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