Drug Reaction With Eosinophilia And Systemic Symptoms Research Articles

Drug reaction with eosinophilia and systemic symptoms: Analysis of cutaneous phenotype as a prognosis factor

Study objectiveThe DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is a severe and potentially fatal toxidermia due to various visceral involvements. Identifying factors predisposing to serious complications is essential for clinical and therapeutic management. This study aims to analyze the cutaneous presentation of DRESS and its role as a prognostic factor. Patients and methodsThis is a retrospective, descriptive, and analytical study conducted over nine years at the dermatology department in Fes, including all hospitalized DRESS cases. ResultsThe maculopapular rash was the most frequent phenotype (49.3%), followed by erythroderma, morbilliform exanthem, and polymorphous erythema-like rash. In all, 52.8% of patients had renal involvement and 45.8% had hepatic involvement, while 81.9% exhibited hypereosinophilia. The maculopapular rash and erythroderma were more associated with internal organ involvement, although no significant statistical correlation could be demonstrated. Allopurinol was the most implicated drug in 51.4% of the cases. No correlation was found between the type of medication and the cutaneous presentation. In all, 8.3% of the patients died, primarily those with erythroderma (15.8%). ConclusionOur study demonstrated that maculopapular rash and erythroderma are the most common presentations and are most associated with internal organ complications, with a more unfavorable prognosis for erythrodermic cases.

Implementation of HLA-related genotype-guided prescribing in Singapore.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To describe the implementation of human leukocyte antigen (HLA)-related genotype-guided prescribing in Singapore. Various HLA alleles have been implicated in drug hypersensitivity syndromes (DHS). These include HLA-B*15:02, which has been associated with carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis, HLA-B*58:01, which has been associated with increased risk of severe cutaneous adverse reactions with allopurinol use, and HLA-B*57:01, which has been associated with increased risk of hypersensitivity reactions with abacavir use. Integrating pharmacogenomics into patient care through genotype-guided prescribing potentially optimizes use of these drugs by reducing DHS-related and healthcare costs. We describe the prevalence of HLA-related DHS in Singapore, the cost-effectiveness of genotype-guided prescribing, and local policies and guidelines, as well as the impact of genotype-guided prescribing where available. HLA-related genotype-guided prescribing has the potential to reduce the incidence of DHS and decrease healthcare costs, as seen in the success with carbamazepine. However, not all genotype-guided prescribing is cost-effective when implemented across the population, as was evident from local studies for allopurinol and abacavir. The cost-effectiveness of such measures may change over time with new data (eg, allele frequencies, test costs, drug prices, genotyping approach) and should be evaluated periodically and locally. Implementation of preemptive pharmacogenomics panel testing as part of routine clinical care may shift the threshold for cost-effectiveness and brings promise of further optimization of pharmacotherapy through precision medicine.

Drug-Specific Presentation and Outcome of Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS) in Children: A Scoping Review.

Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS) is a severe adverse drug reaction with significant variation between patients concerning presenting symptoms and disease severity. Under the hypothesis that the clinical presentation of DReSS is drug-specific, we performed a scoping review and identified 644 cases of pediatric DReSS. A single implicated drug was present in 262 cases, and drugs with 10 or more cases were included in this analysis (n=224): carbamazepine (n=86), dapsone (n=16), lamotrigine (n=25), phenobarbital (n=38), phenytoin (n=45), and trimethoprim-sulfamethoxazole (n=14). Dapsone was associated with increased organ involvement, the highest mortality rate, and the longest period of hospitalization. In addition, we showed that trimethoprim-sulfamethoxazole was associated with higher rates of auto-immune sequelae. This study confirms that drug-specific features exist and may impact the acute and long-term management of DReSS in children.

A Novel Case of Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Secondary to Acalabrutinib

A Novel Case of Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Secondary to Acalabrutinib

Amoxicillin and lamotrigine-induced DRESS syndrome: Acase report.

This case demonstrated with importance of recognizing DRESS syndrome presenting without the typical eosinophilia due to possible cross-reactivity between amoxicillin and the well-documented inciting medication lamotrigine. Steroid tapering is an effective treatment, but medication avoidance should be stressed to avoid symptom recurrence.

S4495 Not DRESSed for Success: A Case of DRESS Syndrome With Progressively Elevated Aminotransferases Even After Stopping Offending Agent

S4495 Not DRESSed for Success: A Case of DRESS Syndrome With Progressively Elevated Aminotransferases Even After Stopping Offending Agent

S4567 A Rare Case of Olanzapine-Induced Liver Injury Due to DRESS Syndrome

S4567 A Rare Case of Olanzapine-Induced Liver Injury Due to DRESS Syndrome

CASE REPORT ON DRESS SYNDROME INDUCED BY ANTITUBERCULOSIS DRUGS

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characterized by an extensive skin rash in association with visceral organ involvement, lymphadenopathy, eosinophilia, and atypical lymphocytosis. We report a rare case of DRESS Syndrome secondary to anti tubercular treatment (ATT). A 53 year old male with pulmonary tuberculosis (TB) presented with fever, facial puffiness, bilateral pedal edema, itchy exfoliative rashes over face, thorax, abdomen, and extremities for 15 days after about 4 months of starting FDC of ATT. On examination there was hypotension (BP-80/60 mm Hg) and bilateral diffuse symmetrical exfoliative dermatitis over face, chest, abdomen, all 4 extremities sparing flexor aspect of thighs and legs. Investigations revealed eosinophilia, leucocytosis (predominantly lymphocytosis), raised alkaline phosphatase and acute kidney injury. FDC was withheld, skin biopsy was performed and the patient was managed as DRESS syndrome fulfilling diagnostic criteria with oral steroids (prednisolone 1mg/kg/day) and other supportive medications. The patient improved gradually with improvement in most of the symptoms and progressive return of laboratory parameters towards normal level. Individuals diagnosed with pulmonary TB who are undergoing treatment with FDC of ATT have a heightened susceptibility to DRESS. The timely identification and cessation of the offending agent can effectively mitigate mortality.

Bilateral purtscher-like retinopathy associated with DRESS syndrome: a case report

BackgroundTo report a case of Bilateral Purtscher-like retinopathy associated with DRESS syndrome managed with ocular and systemic treatments.Case presentationA 29-year-old healthy female developed multi-organ (cutaneous, hematologic, renal and hepatic) disfunction and profound vision loss 1 month after Human papillomavirus vaccine injection. At the first presentation, her visual acuity was counting fingers in both eyes. Fundus exam showed remarkable cotton-wool spots, retinal hemorrhages and macular edema. She was diagnosed DRESS syndrome and Purtscher-like retinopathy and treated with intravitreal injection of ranibizumab, systemic steroids anticoagulants, and plasma exchange. The patient finally recovered from this life-threatening condition but left with permanent visual damage.ConclusionPurtscher-like retinopathy could be complicated by DRESS syndrome which is usually considered a type IV hypersensitivity reaction.

DRESS syndrome and tuberculosis: Implementation of a desensitization and re-desensitization protocol to recover antituberculosis drugs in a case series at a specialized TB Unit in Lima, Peru.

Antituberculosis drugs (ATDs) could cause severe and rare reactions, such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Recovering ATDs might guarantee a higher cure rate for tuberculosis patients. Our aim was to evaluate the results of desensitization and re-desensitization to recover ATDs in a case series of patients with DRESS syndrome. A retrospective case series study was conducted on patients with DRESS syndrome due to therapy with ATDs from 2021 to 2023. Desensitization and re-desensitization protocols, designed with an algorithm proposed by the Tuberculosis Specialized Unit of the Dos de Mayo National Hospital in Lima, Peru, were implemented. A total of 18 patients underwent desensitization or re-desensitization protocols, achieving an overall success rate of 72.2%. The average time for the development of DRESS syndrome due to ATDs was 19 days. Rifampicin (84.2%), isoniazid (68.4%), and pyrazinamide (26.3%) were identified as the main drugs responsible for this adverse reaction. All patients presented with fever and skin rash, with an average eosinophil percentage of 16.7% (interquartile range: 4.5-28.8). Organ involvement (liver, kidney, and heart) was observed in 8 patients, but only 2 patients experienced severe complications due to DRESS syndrome. A significant association was found between the number of ATDs used and eosinophil levels (P =.03). The study introduced a desensitization and re-desensitization algorithm for the treatment of DRESS syndrome, notable for its safety, adaptability, and high success rate. This advancement provided healthcare professionals with safer and more effective therapeutic approaches for managing this complex condition.

Drug-induced hypersensitivity syndrome due to phenytoin: Case report and review of the literature.

Drug hypersensitivity syndrome (DIHS) is a rare but potentially fatal adverse drug reaction characterized by fever, rash, and visceral organ damage, particularly affecting the liver. Early recognition and appropriate management are crucial to prevent serious complications. However, there is limited information on the clinical presentation and management of DIHS, especially in the context of antiepileptic drugs. This case report aims to highlight the importance of recognizing subtle clinical signs and symptoms of DIHS, which can be easily overlooked, particularly in the context of antiepileptic drug use. We report a case of a 15-year-old male patient who developed DIHS after being prescribed phenytoin sodium for epilepsy. The patient presented with symptoms of fever, sore throat, rash, jaundice, and liver dysfunction. Initially, the patient did not receive glucocorticoids and experienced additional reactions to cefoxitin and phosphatidylcholine, likely due to cross-reactivity. The diagnosis of DIHS was made based on the patient's clinical presentation, including fever, extensive rash, organ involvement, and hematological abnormalities. The temporal association with the use of phenytoin sodium, along with the exclusion of other causes of fever and rash, supported the diagnosis. Upon initiation of glucocorticoid therapy with dexamethasone, the patient's symptoms significantly improved. The rash and pruritus decreased, and laboratory values showed improvement, with a decrease in liver enzymes and normalization of white blood cell counts. The patient's fever resolved within 48 hours of starting corticosteroids, and there was no evidence of ongoing inflammation as indicated by a decrease in C-reactive protein levels. Furthermore, the patient's 30-month follow-up revealed no recurrence of rash, liver dysfunction, or organic damage, indicating the long-term effectiveness of the treatment administered. This case highlights the importance of recognizing the subtle clinical signs and symptoms of DIHS, especially in the context of antiepileptic drug use. It underscores the potential benefits of early initiation of glucocorticoid therapy in managing DIHS. The case also serves as a reminder of the potential for drug cross-reactivity in DIHS and the need for cautious drug selection during the acute phase of the syndrome.

Divulge the Dual Challenge: A Case Report of Phenytoin Induced Dress Syndrome and Steroid-Induced Hyperglycaemia

Divulge the Dual Challenge: A Case Report of Phenytoin Induced Dress Syndrome and Steroid-Induced Hyperglycaemia

Síndrome Dress por uso de Trimetropin Sulfametoxazol

The term DRESS was introduced in 1996 to describe a drug reaction with eosinophilia, skin eruption and systemic symptoms. Potentially fatal drug reactions include three distinct entities: DRESS syndrome, acute generalized exanthem and Stevens-Johnson syndrome/toxic epidermal necrolysis. We report a case of DRESS syndrome in a female patient who attended Hospital de San José in Bogotá, for presenting a cutaneous reaction induced by trimethroprim/sulfamethoxazole. The physiopathology, diagnosis, clinical features and treatment, are outlined herein.

Distinguishing DRESS syndrome from drug rash and eosinophilia: Beyond RegiSCAR criteria

BackgroundDiagnosing drug reaction with eosinophilia and systemic symptoms (DRESS) can be challenging. ObjectivesTo identify clinical and laboratory features outside of the RegiSCAR criteria which distinguish patients with probable DRESS (RegiSCAR >/=4) from those who have drug rash and eosinophilia (DRE). MethodsUsing International coding classification of drug induced fever, generalised skin eruption due to medications and eosinophilia, a retrospective audit of hospitalized patients was performed from 2008 to 2023. ResultsForty-four cases of DRESS were compared to 80 cases of DRE. In addition to the RegiSCAR distinguishing factors for DRESS were longer drug latency prior to symptom onset (median 21 vs 5 days, p<0.001)and higher alanine transaminase (ALT) levels (increase by a factor of 2.49 (95% CI: 1.56, 4.00; p=0.009). Follow-up (mean 5.67 years) revealed a low rate of statewide drug alert reporting (29.6%) and drug allergy testing in DRESS (20.5%). Inadvertent re-exposure to a culprit or structurally-related drug resulted in recurrent DRESS in three patients (7.5%), and tolerance of structurally related drugs in 8 patients (17.5%). ConclusionThis is the largest study to date evaluating DRE patients that don’t meet RegiSCAR criteria for DRESS. We highlight additional factors outside the RegiSCAR which may help clinicians differentiate DRESS which is critical for optimal and timely patient management. Our study also highlights the need for development of local protocols to ensure appropriate allergy labeling and testing is performed to prevent recurrent DRESS.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome with Multiple Drugs (Leflunomide and Cefuroxime): A Case Report

Background: Adverse Drug Reactions (ADRs) are unexpected reactions to a medicine administered in the correct manner and at the proper dosage. Drug Rash with Eosinophilia and Systemic Symptoms syndrome (DRESS syndrome) is a Severe Cutaneous Adverse Reaction (SCAR) type of ADR with complicated clinical features involving several organ systems of the body; frequently involved organs are the liver, kidney, lungs, and other organs. Prompt recognition and correct diagnosis, followed by withdrawal of the causative agent, can promote appropriate treatment, accelerate recovery, and reduce the related morbidity and mortality. Case presentation: We have, herein, presented a case of a 42-year-old female with a history of leflunomide intake for plantar fasciitis. The patient subsequently developed fever, gastrointestinal tract disturbance, facial edema, liver injury, skin rash, hematologic abnormalities (eosinophilia), hepatosplenomegaly, and lymph node enlargement. The probability of leflunomide-induced DRESS syndrome was rated as “definite”, with seven scores graded by RegiSCAR. The suspected causative agent was withdrawn, and the patient was managed symptomatically. Following her management and discharge, she again encountered similar complaints after administration of the cefuroxime tablet. The causality assessment of the reactions was done using the WHO-UMC scale and Naranjo’s assessment scale, and a “probable” reaction was found for both drugs. Conclusion: The presented case contributes to the existing global literature regarding exceptional clinical presentations. Leflunomide and cefuroxime drugs have the potential to cause DRESS syndrome. Thus, they should be handled cautiously, and if such a reaction occurs, it should be reported to the responsible authorities.

Suture-Less and Glue-Less Amniotic Membrane Graft for Keratopathy and Early Keratinization in Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome

Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can cause significant keratopathy and lead to lasting visual effects. The main objective of this study was to describe an ocular presentation of DRESS treated with a modified suture-less and glue-less amniotic membrane graft technique. This study also provides a literature review of ocular DRESS manifestations and ocular management of the other severe cutaneous adverse reactions. Methods: This is a case review about an 82-year-old man with sepsis due to recent Mycobacterium tuberculosis, who presented with DRESS based on clinical findings. Results: The patient was treated with a modified suture-less and glue-less amniotic membrane graft technique along with a Prokera corneal bandage placement. The patient had significant improvement of visual acuity and symptoms with this technique. Conclusions: Patients with significant corneal and conjunctival involvement associated with DRESS, similar to Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), may benefit from more aggressive treatment with amniotic membrane transplantation and Prokera corneal bandage placement to prevent scarring and subsequent vision loss. The modified technique described in this article can be used for patients who may be poor candidates for the operating room.

50743 Histopathologic Features of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

50743 Histopathologic Features of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

50925 Morbidity and mortality of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in hospitalized patients

50925 Morbidity and mortality of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in hospitalized patients

Investigating Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) reported in association with HIV antiretroviral therapy: An analysis of the FDA Adverse Event Reporting System

Investigating Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) reported in association with HIV antiretroviral therapy: An analysis of the FDA Adverse Event Reporting System

Drug fever-an immune-mediated delayed type hypersensitivity reaction to Vinca alkaloids in pediatric oncology patients, possibly mediated by cysteinyl leukotrienes.

Drug hypersensitivity reactions are common in pediatric hemato-oncology patients due to multiple factors including immune compromise and pharmacological complexities. Fever can signify severe delayed-type hypersensitivity reactions such as drug reaction with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome (DIHS). The etiology of fever as an isolated hypersensitivity reaction to chemotherapeutic agents not fully understood. Here, we report three children with intracranial neoplasms experiencing recurrent febrile reactions following Vinca alkaloid-based chemotherapy, mitigated by cysteinyl leukotriene receptor antagonist therapy. We present a series of pediatric patients with diverse intracranial neoplasms who developed recurrent fever episodes after multiple courses of Vinca alkaloid-based chemotherapy. Treatment involved prophylactic and post-chemotherapy administration of a cysteinyl leukotriene receptor antagonist to prevent fever episodes and enable completion of chemotherapy regimens without protocol modifications or desensitization. All three patients experienced fever consistent with delayed-type hypersensitivity reactions to Vinca alkaloids. Prophylactic use of the leukotriene antagonist Montelukast successfully prevented fever recurrence, allowing uninterrupted completion of chemotherapy courses. Our findings suggest that Montelukast, a leukotriene antagonist, may be beneficial in managing fever as a delayed-type hypersensitivity reaction to Vinca alkaloids in pediatric patients. Further research is warranted to elucidate the underlying mechanisms and leukotriene pathways involved in drug-induced fever reactions.