Clinical studies of children with severe sepsis combined with drug hypersensitivity syndrome

Abstract

Objective To discuss how to treat and prevent severe sepsis which was combined with drug hypersensitivity syndrome (DHS) in children by studying the clinical features and laboratory results of severe sepsis with DHS in children. Methods The clinical data of sixteen patients (9 boys and 7 girls, aged from 7 months to 7 years)with severe sepsis combined with DHS in Capital Institute of Pediatrics Affiliated Children's Hospital from January 2009 to April 2014 were reviewed and analyzed.Clinical characteristics, laboratory examinations, radiographic findings and the treatment were analyzed. Results In this study, DHS happened in all patients with severe sepsis during the treatment and recovery periods.The incubation period was about 14-21 days.All 16 patients had fever, skin widespread rash, lymphadenopathy and internal organ involvement, among which 8 patients had elevated level of eosinophil and 4 patients had reactivated human herpes virus type 6 (HHV-6). Sensitization drugs were cephalosporins (10 cases), vancomycin(6 cases). After stopping the use of suspected drugs, static drops of Methyl prednisolone and intravenous immunoglobulin therapy(IVIG) were given to them, and 16 cases were cured after active treatment. Conclusions DHS is a severe adverse drug-induced reaction.It is challenging to diagnose DHS, which is due to the diversity of cutaneous eruption and multiple organs involved.DHS can be misdiagnosed due to its non-specific and variable presentations.But given its significant mortality, failure to make a right diagnosis can be disastrous.Early recognition, early diagnosis and early treatment are the keys to decrease the morbidity and mortality of severe sepsis combined DHS.Better understanding of DHS may contribute to the improvement of the diagnosis and management of this syndrome in the clinical practice. Key words: Child; Severe sepsis; Drug hypersensitivity syndrome