Drug Reaction With Eosinophilia And Systemic Symptoms Research Articles

Ciprofloxacin Ophthalmic DRESS Syndrome: Case Report

Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS syndrome), also known as drug-induced hypersensitivity syndrome, is a rare severe systemic hypersensitivity drug reaction. Diagnosing DRESS syndrome is challenging due to non-specific manifestations that can make it difficult to recognize. Therefore, addressing and discussing this issue is extremely important, considering the potential lethality of a treatable syndrome. Clinical case: We describe the clinical characteristics of a 39-year-old female who presented with DRESS syndrome associated with the use of ciprofloxacin ophthalmic. The patient manifested a mild maculopapular rash located in the pelvic limbs with subsequent ascending distribution and generalized erythematoviolaceous affecting four extremities, trunk, facial region and scalp, together with fever and lymphadenopathy. Paraclinical tests revealed leukocytosis and eosinophilia. According to RegiScar's ranking, it scored 6 points, classifying it as the definitive case for DRESS. He concluded a schedule with prednisone 1 mg/kg/day with a slow reduction dose, obtaining a good response to treatment. Conclusions: DRESS syndrome should be suspected in a patient receiving medical treatment who presents with the following signs and symptoms: rash, fever (38°C), facial edema, and lymphadenopathy. Fortunately, this reaction is usually reversible, with a low incidence of residual damage or mortality, in the case of timely discontinuation of antibiotics and use of topical or systemic corticosteroids.

FDA issues warning on some antiseizure medications

On November 28, 2023, the FDA warned of rare but serious drug reaction to the antiseizure medicines levetiracetam (Keppra, Keppra XR, Elepsia XR, Spritam) and clobazam (Onfi, Sympazan) This reaction is called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). It may start as a rash but can quickly progress, resulting in injury to internal organs, the need for hospitalization, and even death. As a result, we are requiring warnings about this risk to be added to the prescribing information and patient Medication Guides for these medicines. This hypersensitivity reaction to these medicines is serious but rare. DRESS can include fever, rash, swollen lymph nodes, or injury to organs including the liver, kidneys, lungs, heart, or pancreas.

Levetiracetam and clobazam may cause DRESS syndrome

Levetiracetam and clobazam may cause DRESS syndrome

Atypical Intralymphatic T-Cell Proliferation during DRESS Mimicking Intravascular Lymphoma: Case Report

Drug-induced hypersensitivity syndrome or drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug-induced reaction that represents a life-threatening condition. The histopathologic appearance of the skin biopsy is nonspecific but may exceptionally show an atypical intralymphatic lymphocytic infiltrate, and mimic an intravascular lymphoma. Through this article, we will report an exceptional case of a patient presenting with skin lesions pointing to a dress, but whose histological appearance, in the presence of adenopathy during physical examination, can lead, by mistake, to the diagnosis of an intralymphatic lymphoma. We aim to highlight the various diagnostic indices allowing the distinction between these two entities, including the immunohistochemical study, the search for the TcR clonal rearrangement and the anatomo-clinical correlation.

Characterization of drug-induced liver injury associated with drug reaction with eosinophilia and systemic symptoms in two prospective DILI registries.

Idiosyncratic drug-induced liver injury (DILI) associated with drug reactions with eosinophilia and systemic symptoms (DRESS) is poorly characterized among patients of Western countries. We aimed to comprehensively assess the clinical characteristics, outcomes, and causative agents in a prospective, well-vetted cohort of DILI patients with DRESS (DILI-DRESS). We identified 53 DILI-DRESS cases from the Spanish DILI Registry and the Latin American DILI Network. For comparison purposes, we defined a group of DILI patients (n = 881). DILI-DRESS cases were younger (47 vs. 53years, respectively; p = 0.042) and presented more frequently with cholestatic/mixed damage (p = 0.018). Most DILI-DRESS patients showed moderate liver injury, 13% developed severe damage, and only one patient (with hepatocellular injury due to anti-tuberculosis drugs) progressed to acute liver failure and died. DILI-DRESS cases showed a distinctive causative drug pattern compared to DILI cases. The most frequent drugs were carbamazepine (13%), anti-tuberculosis drugs (13%), amoxicillin-clavulanate (11%), and allopurinol and lamotrigine (7.6% each). Among all cases of DILI due to allopurinol and lamotrigine, 67% presented with a DILI-DRESS phenotype, respectively. Higher total bilirubin (TBL) levels at DILI recognition (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.04-1.45) and absence of eosinophilia (OR 8.77; 95% CI 1.11-69.20) increased the risk for developing a severe-fatal injury in DILI-DRESS patients. DILI-DRESS patients have a more frequent cholestasis/mixed pattern of injury at presentation, with antiepileptics as distinctive causative drug class. Most of the lamotrigine and allopurinol cases present with this phenotype. Higher TBL levels and absence of eosinophilia at DILI recognition are markers of poor outcomes.

DRESS syndrome complicated by a severe acute hemolytic anemia

A 25-year-old female patient, who had been receiving treatment for psychosis with carbamazepine, olanzapine, and haloperidol for the past 2 years, was admitted to the hospital after developing a widespread febrile rash. This occurred 15 days after taking fluoxetine and clomipramine. Upon examination, the patient presented with fever, tachycardia, and hypotension. Dermatological examination revealed a generalized erythema with fine scales, accompanied by eyelid swelling and bilateral cervical lymphadenopathy. Laboratory tests showed a normochromic normocytic anemia with a hemoglobin level of 3.5g/dL and lymphopenia with an elevation in LDH. The direct Coombs test was positive. A skin biopsy suggested a drug eruption. The diagnosis of DRESS syndrome was considered probable based on the diagnostic criteria of the RegiSCAR group. DRESS syndrome is a severe hypersensitivity reaction with various clinical manifestations that can be life-threatening. To date, no cases of DRESS syndrome associated with acute hemolytic anemia have been reported in the literature. However, it has been implicated in the development of autoimmune diseases in the medium and long term.

A Rare Case of Rifampicin-induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome

ABSTRACT Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an idiosyncratic adverse drug reaction that can be lethal in up to 20% cases. The commonest culprit drug includes phenytoin, allopurinol, phenobarbital, sulfasalazine and lamotrigine. DRESS syndrome due to antitubercular medicines is rarely reported. In India despite the widespread use of antitubercular medicines, only few cases of DRESS syndrome have been reported. Here we report an interesting case of a 23 year old girl who presented to us with complaints of high grade fever, cough, GI discomfort, numbness, severe pruritus and burning skin sensation. She was receiving antitubercular medicines for tubercular pleural effusion for the last three weeks. She was hospitalised for a suspected adverse drug reaction which was diagnosed as DRESS syndrome on the basis of RegiSCAR criteria. On re-challenge testing the culprit drug was found to be rifampicin. In this case the severity of skin involvement was much higher as compared to organ involvement.

Dapsone induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, sparing leprosy patches as an ‘anatopic’ response: A case report

Dapsone induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, sparing leprosy patches as an ‘anatopic’ response: A case report

Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) With Eosinophilic Cholecystitis Triggered by Topical Diclofenac

Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) With Eosinophilic Cholecystitis Triggered by Topical Diclofenac

РЕАКЦИЯ ЛЕКАРСТВЕННОЙ ГИПЕРЧУВСТВИТЕЛЬНОСТИ С ЭОЗИНОФИЛИЕЙ И СИСТЕМНЫМИ СИМПТОМАМИ (DRESS-СИНДРОМ) НА КАРБАМАЗЕПИН. Клинический случай и обзор литературы

Abstract. Introduction. A drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life- threatening T-cell mediated reaction characterized by heterogeneous clinical manifestations and by a variable and unpredictable course. It is difficult to diagnose this reaction due to the long latent period between the start of therapy with a new drug and onset of symptoms, as well as due to no pathognomonic manifestations. Aim. Providing physicians with an algorithm for the diagnosis and treatment of DRESS syndrome exemplified by our own clinical observation. Materials and Methods. A 70-year-old female patient was hospitalized in the Department of Allergology and Immunology, complaining of generalized itchy rash on the face, body, and extremities, swelling of face and hands, and temperature rise to 37.5-38 °C. She was examined using general clinical, laboratory and instrumental methods. Results and Discussion. On examination, we found generalized maculopapular rash, increased levels of hepatic transaminases, reaching the criteria for mild drug-induced liver damage, and peripheral blood eosinophilia 25% (4,260 cells in 1 μl). Using the RegiSCAR scoring system helped to diagnose drug hypersensitivity reaction with eosinophilia and systemic symptoms, while utilizing the algorithm for assessing the causal relationship between the drug and the development of symptoms allowed considering carbamazepine as a possible cause of this reaction. The patient was treated with systemic and topical glucocorticosteroids with positive changes. Conclusions. Using the RegiSCAR scoring system developed by a team of international experts facilitates diagnosing the DRESS syndrome. Identifying and withdrawing the culprit drug is an essential condition of successfully managing patients. Systemic and topical glucocorticosteroids are the drugs of choice for the treatment of drug reactions with eosinophilia and systemic symptoms.

Treatment in Patients DRESS (Drug Reaction With Eosinophilia And Systemic Symptoms) : Case Report

Drug reactions with eosinophilia and systemic symptom syndrome (DRESS) are rare and potentially life-threatening severe skin adverse reactions (SCAR) The mean age at diagnosis is approximately 50-55 years and less than 10% of patients are under 20 years men : women 0.7-0.8. All drugs used by the patient during DRESS should be stopped immediately. Complications of DRESS are myocarditis, Pneumocystis jiroveciipneumonia, sepsis, liver failure, and gastro-intestinal bleeding. Systemic corticosteroids (prednisolone 1 mg/kg/day) are the gold standard of treatment in the acute phase of patients with severe organ involvement. Therefore, the importance of appropriate therapy to reduce the occurrence of complications from DRESS disease.

Proposed algorithm to recover anti-tuberculosis drugs that cause drug reaction with eosinophilia and systemic symptoms (DRESS)

Sr. Editor, El síndrome de DRESS (por sus iniciales en inglés, reacción a medicamentos con eosinofilia y síntomas sistémicos) es un evento adverso raro debido a una susceptibilidad del paciente por determinados medicamentos. Se estima una incidencia entre 1:1000 y 1:10 000 exposiciones al fármaco y una mortalidad de hasta 20% (1).

A Rare Case of Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome, Eosinophilic Pneumonitis, and Steroid-Resistant Acute Interstitial Nephritis Requiring Additional Immunosuppression: A Case Report

A Rare Case of Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome, Eosinophilic Pneumonitis, and Steroid-Resistant Acute Interstitial Nephritis Requiring Additional Immunosuppression: A Case Report

Say “No” to the DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)

Say “No” to the DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)

Cutaneous adverse drug reactions

Cutaneous adverse drug reactions (ADRs) represent a heterogeneous field including various clinical patterns without specific features suggesting drug causality. Maculopapular exanthema and urticaria are the most common types of cutaneous ADR. Serious cutaneous ADRs, which may cause permanent sequelae or have fatal outcome, may represent 2% of all cutaneous ADR and must be quickly identified to guide their management. These serious reactions include bullous manifestations (epidermal necrolysis i.e. Stevens-Johnson syndrome and toxic epidermal necrolysis), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). Some risk factors for developing cutaneous ADRs have been identified, including immunosuppression, autoimmunity or genetic variants. All drugs can cause cutaneous ADRs, the most commonly implicated being antibiotics (especially aminopenicillins and sulfonamides), anticonvulsants, allopurinol, antineoplastic drugs, non-steroidal anti-inflammatory drugs and iodinated contrast media. Pathophysiology is related to immediate or delayed "idiosyncratic" immunologic mechanisms, i.e., usually not related to dose, and pharmacologic/toxic mechanisms, commonly dose-dependent and/or time-dependent. If an immuno-allergic mechanism is suspected, allergological explorations (including epicutaneous patch testing and/or intradermal test) are often possible to clarify drug causality, however these have a variable sensitivity according to the drug and to the ADR type. No in vivo or in vitro test can consistently confirm the drug causality. To determine the origin of a rash, a logical approach based on clinical characteristics, chronologic factors and elimination of differential diagnosis (especially infectious etiologies) is required, completed with a literature search. Reporting to pharmacovigilance system is therefore essential both to analyze drug causality at individual level, and to contribute to knowledge of the drug at population level, especially for serious cutaneous ADRs or in cases involving newly marketed drugs.

Letter to the Editor Regarding “DRESS syndrome on the background of adding meropenem to carbamazepine therapy: a clinical case”

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Fatal eosinophilic myocarditis and submassive hepatic necrosis in lamotrigine induced DRESS syndrome

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare but severe and sometimes fatal adverse drug reaction that is known to occur with a number of antiepileptic drugs. It often follows a prolonged clinical course, which can worsen even after discontinuing the causative drug and administering steroid treatment. Failure to promptly identify the delayed involvement of vital organs, such as the heart and liver, may result in irreversible organ failure and death. We report a case of a presumed sudden death of a young woman who had a documented history of a protracted intermittent hypersensitivity reaction to lamotrigine. Postmortem examination revealed the presence of eosinophilic myocarditis and submassive hepatic necrosis diagnostic of fatal DRESS syndrome that progressed despite early discontinuation of the medication and improvement of dermatologic and hematologic symptoms following steroid therapy.

The usefulness of omalizumab in low response to corticosteroids DRESS syndrome: A case series

The usefulness of omalizumab in low response to corticosteroids DRESS syndrome: A case series

Cutaneous adverse effects of antiepileptic drugs

Antiepileptic drugs (AED) are widely used in therapy. They are mainly indicated in the treatment of epilepsy and some psychiatric pathologies as well as for their analgesic action. Their cutaneous adverse effects (CAE) are common, often mild but sometimes serious. The aim of this work was to study the epidemiological and clinical features of CAE occurring in adults and elderly patients (aged over 20 years-old) and to identify the most implicated AED. We conducted a descriptive retrospective study over a period of five years from January 2017 to December 2022 about CAE of AED in adults and elderly patients notified to The National Center Chalbi Belkahia of Pharmacovigilance (Tunis,Tunisia). All cases were analyzed according to the updates French methods of imputability. We collected 71 cases of patients aged over 20 years old who presented CAE to AED. The age ranged from 20 to 79 years (mean age=44.8 years). The sex ratio F/M was 0.7. AED were indicated for neurological pathology in 70.5% of cases, for psychiatric pathology in 15.9% of cases and for their analgesic action in 12.9% of cases. Epilepsy was the first indication (51.1% of cases). The most notified CAE in our study were drug reaction with eosinophilia and systemic symptoms (DRESS syndrome; 34% of cases), maculopapular exanthema (MPE; 26% of cases), erythematous rash (8% of cases) and photosensitivity in 5% of cases. Severe cutaneous adverse reactions were accounted for 37% of all CAE. The most implicated AED were carbamazepine (52%), phenobarbital (24%) and lamotrigine (18%). However, further study with a larger number of patients and in collaboration with prescribing physicians are needed to better clarify features of CAE associated with AED intake and specify the risk factors, specific to our Tunisian population.

Diagnosis and Management of the Systemic Juvenile Idiopathic Arthritis Patient with Emerging Lung Disease.

Chronic lung disease in children with systemic juvenile idiopathic arthritis (SJIA-LD) is an emerging and potentially life-threatening disease complication. Despite recent descriptions of its clinical spectrum, preliminary immunologic characterization, and proposed hypotheses regaarding etiology, optimal approaches to diagnosis and management remain unclear. Here, we review the current clinical understanding of SJIA-LD, including the potential role of biologic therapy in disease pathogenesis, as well as the possibility of drug reactions with eosinophilia and systemic symptoms (DRESS). We discuss approaches to evaluation of children with suspected SJIA-LD, including a proposed algorithm to risk-stratify all SJIA patients for screening to detect LD early. We review potential pharmacologic and non-pharmacologic treatment approaches that have been reported for SJIA-LD or utilized in interstitial lung diseases associated with other rheumatic diseases. This includes lymphocyte-targeting therapies, JAK inhibitors, and emerging therapies against IL-18 and IFNγ. Finally, we consider urgent unmet needs in this area including in basic discovery of disease mechanisms and clinical research to improve disease detection and patient outcomes.