Eosinophilia Syndrome Research Articles

Sindrome DRESS: da un caso clinico particolare alla rivisitazione della patologia

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. Anti-convulsants are the main drugs involved both in adults and in children. Incidence of DRESS in children is very variable, from 1:1,000 to 1:10,000, and the mortality rate seems to be lower than 10%. The treatment of choice is the prompt withdrawn of the offending drug and using intravenous immunoglobulins and corticosteroids used in synergy.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 paediatric 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.

"Heart in DRESS": Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review.

Cardiac involvement in drug reaction with eosinophilia and systemic symptoms (DS) is rare but associated with high mortality. The aim of this research was to systematically review case reports by PRISMA guidelines in order to synthetize the knowledge of cardiac manifestations of DS. We identified 42 cases from 36 case reports. Women were two times more affected than men. Two-thirds of patients had cardiac manifestation in the initial phase of the disease, while in one-third of cases cardiac manifestations developed later (mean time of 70 ± 63 days). The most common inciting medications were minocycline (19%) and allopurinol (12%). In 17% of patients, the heart was the only internal organ affected, while the majority (83%) had at least one additional organ involved, most commonly the liver and the kidneys. Dyspnea (55%), cardiogenic shock (43%), chest pain (38%), and tachycardia (33%) were the most common cardiac signs and symptoms reported. Patients frequently had an abnormal ECG (71.4%), and a decrease in left ventricular ejection fraction was the most common echocardiographic finding (45%). Endomyocardial biopsy or histological examination at autopsy was performed in 52.4%, with the predominant finding being fulminant eosinophilic myocarditis with acute necrosis in 70% of those biopsied. All patients received immunosuppressive therapy with intravenous steroids, while non-responders were more likely to have received IVIG, cyclosporine, mycophenolate, and other steroid-sparing agents (60%). Gender and degree of left ventricular systolic dysfunction were not associated with outcomes, but short latency between drug exposure and the first DRESS symptom onset (<15 days) and older age (above 65 years) was associated with death. This underscores the potential importance of heightened awareness and early treatment.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome induced by ceftriaxone with successful treatment — A case report and literature review

Drug reaction with eosinophilia and systemic symptoms is a rare and potentially life threatening condition characterised by hypersensitivity reactions to a drug with prolonged latency, in the form of skin rashes, hyper eosinophilia and systemic features like fever, lymphadenopathy, leucocytosis, internal organ involvement (liver, kidney, lung). Though it can occur in response to many drugs but very few cases has been described in relation to one of the most commonly used antibiotic ceftriaxone. Here we have described a case of DRESS in a patient who has been treated with ceftriaxone outside our hospital for sore throat.

Anti-Tuberculosis Treatment Induced DRESS Syndrome – A Case Report

Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a medical condition that is a severe adverse drug event. Anti-tuberculosis medications may precipitate this condition.&#x0D; Study Design: Case presentation.&#x0D; Place and Duration of Study: Sample: Department of internal Medicine, and Department of Pathology, Krishna Institute of Medical Sciences (KIMS) Hospital, HYDERABAD,&#x0D; Methodology: A 73-year-old gentleman had complaints suggestive of left ankle arthritis of 8 months duration and was diagnosed with tuberculous osteomyelitis 6 weeks ago based on positive Gene-Expert® MTB/RIF(mycobacterium tuberculosis resistant rifampicin) and necrotizing granulomatous inflammation on histopathology. He was started on anti-tuberculosis treatment and presented 6 weeks later with high-grade fever, generalized rashes, and itching. Eosinophilia was noted in the complete hemogram and liver enzymes were elevated. Skin biopsy showed SJS (Stevens-Johnson syndrome). He was diagnosed as drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. It was most likely caused by Anti-Tuberculosis medications. His tuberculosis medications were modified and steroids were started after which his condition improved.&#x0D; Discussion: This case presentation depicts, most of the first-line anti-tuberculosis medications can cause DRESS Syndrome. Clinical suspicion and early diagnosis with appropriate tests help to treat this condition early without any significant morbidity and mortality. The causative drug should be withdrawn, Steroids, and Intravenous immunoglobulin-g can be used for the treatment depending on the severity.

Quetiapine-induced drug rash with eosinophilia and systemic symptom syndrome

Drug rash with eosinophilia and systemic symptoms (DRESSs) syndrome is an adverse cutaneous reaction characterized by fever, skin eruption, hematological abnormalities, and internal organ involvement. Although many drugs are known to cause DRESS syndrome, quetiapine-induced DRESS syndrome case is rare. We report a case of a 78-year-old male who developed DRESS syndrome presented with rashes, eosinophilia after taking quetiapine for 2 weeks.

Diagnostic Challenges of Old Diseases in the COVID-19 Era: A Report of Two Cases of Carbamazepine-Induced DRESS Syndrome

A new MIS-C that develops after the acute stage of COVID-19 infection has recently been reported worldwide. Drug reaction with eosinophilia and systemic symptoms syndrome is a rare but potentially severe adverse drug-induced reaction most commonly associated with anticonvulsants. Due to variability in clinical presentation involving cutaneous and multiorgan systems, broad differential diagnosis, and lack of definitive diagnostic tests, diagnosis may be delayed. The authors report 2 cases of pediatric patients who presented with fever, diffuse rash, and exposure to COVID-19 infection with suspected MIS-C. Both patients' medical histories revealed carbamazepine treatment for approximately 2 months. The diagnosis of DRESS syndrome was associated with the use of carbamazepine. Distinguishing between MIS-C and DRESS syndrome may be difficult due to similar clinical and laboratory features and the lack of definitive diagnostic tests for either condition. When encountering cases like the current report, it is important to consider DRESS syndrome for early diagnosis and medical intervention.

Fever with pancytopenia in a patient with lamotrigin induced DRESS syndrome: a case-based review

Background: Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare idiosyncratic and unpredictable drug reaction most commonly attributed to anticonvulsants, allopurinol, and antibiotics. Fever in combination with cutaneous manifestations and eosinophilia are the cardinal clinical findings, while organ involvement and very rarely pancytopenia can be present. Case presentation: We describe a 26-year-old female patient with pancytopenia in the context of lamotrigine-induced DRESS and we summarize this as a potentially life-threatening hypersensitivity reaction. Conclusion: DRESS should be suspected in patients presenting with fever, eosinophilia, skin involvement, and/or visceral organ involvement, who have started a new drug during the past 2 to 6 weeks, as early recognition of this syndrome with subsequent discontinuation of the offending drug could be lifesaving.

Morphologic Spectrum of Lymphadenopathy in Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome.

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DRESS) is a drug-induced, adverse T-cell-mediated hypersensitivity reaction that most often involves skin. The pathologic findings of DRESS-related lymphadenopathy have been described infrequently in the literature. To present a case series of DRESS-related lymphadenopathy with an emphasis on the morphologic spectrum. We describe detailed clinical and pathologic findings along with the literature review. We focus on the differential diagnosis between DRESS lymphadenopathy and angioimmunoblastic T-cell lymphoma (AITL). There were 4 men and 1 woman with a mean age of 41 years (range, 23-59 years). One patient (20%) died. Three lymph node biopsy specimens showed a pattern reminiscent of AITL (AITL-like pattern) and 2 cases showed necrotizing lymphadenitis (Kikuchi-like pattern), associated with vasculitis in 1 case. The AITL-like morphology of DRESS-related lymphadenopathy may be difficult to distinguish from genuine AITL. The clinical information is important for differential diagnosis, including history of drug exposure, age, and the rarity or absence of AITL-associated manifestations such as hemolytic anemia and hypergammaglobulinemia. Molecular analysis of the T-cell receptor genes is helpful, typically revealing a polyclonal pattern in DRESS-related lymphadenopathy. In the literature, 4 histologic patterns of DRESS lymphadenopathy have been described: reactive lymphoid hyperplasia, necrotizing lymphadenitis, Hodgkin lymphoma-like, and AITL-like. These patterns, particularly those that resemble lymphoma, highlight the importance of correct diagnosis to avoid unnecessary therapies.

DRESS syndrome in the setting of oxacillin therapy\u2014a call for better patient preparedness: a case report

BackgroundDrug reaction with eosinophilia and systemic symptoms syndrome is a rare but severe and potentially life-threatening hypersensitivity reaction, with significant morbidity and mortality. The clinical presentation of drug reaction with eosinophilia and systemic symptoms may include extensive skin rash, fever, lymphadenopathy, internal organ involvement, eosinophilia, and atypical lymphocytosis, most commonly due to drug-induced reaction. Our case is a rare occurrence of drug reaction with eosinophilia and systemic symptoms syndrome in the setting of oxacillin therapy.Case presentationA 55-year-old Caucasian male presented to the emergency department on account of acute onset, 2-day history of generalized pruritic rash with associated fever, occurring 3 weeks after commencing therapy with intravenous oxacillin for methicillin-sensitive Staphylococcus aureus bacteremia. He had no known drug allergies. Two days prior to hospitalization, he had a telehealth visit with the infectious diseases specialist on account of his rash, and was recommended to use oral diphenhydramine. However, with the onset of fever and persistence of his rash, he was advised to discontinue the oxacillin and present to the emergency department. On examination, he was febrile at 101.2 °F and had a generalized blanchable maculopapular and morbilliform rash involving the face, trunk, upper and lower extremities, but sparing the palms, soles, and oral mucosa. He had palpable nontender lymph nodes in the cervical and inguinal regions bilaterally. Laboratory studies revealed atypical lymphocytosis, eosinophilia, neutrophilia, and elevated serum transaminases. He was started on intravenous diphenhydramine and admitted to the in-patient medical service. On the second day of hospitalization, his fever resolved. However, his rash was persistent and generalized, as well as elevated transaminases and an abnormal cell count on the second day of hospitalization. To complete his 6-week course of antibiotics for methicillin-sensitive Staphylococcus aureus bacteremia, he was switched to an alternative therapy with cefazolin, and he was scheduled for weekly follow-up assessments following hospital discharge.ConclusionsHealthcare providers should increasingly be aware of the significant morbidity and mortality attributable to drug reaction with eosinophilia and systemic symptoms syndrome and the potential medications which may incite such life-threatening reactions. Early recognition of drug reaction with eosinophilia and systemic symptoms syndrome and prompt institution of management strategies can promote improved clinical outcomes. Enhanced patient–provider communication strategies should be implemented to better prepare patients for the likelihood of such drug reactions, with the goal of improving patient-centered care and adherence with treatment strategies.

Efficacy of add-on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, potentially life‐threatening, delayed, drug‐induced hypersensitivity reaction. Immediate withdrawal of the culprit drug and administration of systemic corticosteroids is the most widely accepted treatment. However, it is difficult to manage patients with DRESS syndrome who are not responsive to systemic steroids. We studied the efficacy of intravenous immunoglobulins (IVIGs) in patients with DRESS syndrome unresponsive to systemic steroids. We retrospectively reviewed patients with DRESS syndrome who received IVIG in addition to systemic steroids during 2012–2017 and compared the clinical features and course of DRESS syndrome, before and after IVIG treatment. Eighteen DRESS patients (9 men) were included. The most frequent offending drugs were dapsone in five patients, followed by vancomycin in three patients, and carbamazepine in three patients. Rash, fever, lymphadenopathy, atypical lymphocytes, and hepatic involvement were common clinical findings. IVIG treatment was added within a median time of 7 days from the commencement of systemic steroid therapy. After IVIG treatment (total dosage: 1–2 g/kg), the fever resolved within a median time of 1 day (range, 0–3) and liver enzymes improved substantially within a median time of 13 days (range, 0–27). No severe adverse reactions related to IVIG therapy were observed in this study; however, there was one case of mortality. The addition of IVIG in DRESS syndrome in cases refractory to systemic steroid treatment may be helpful in hastening recovery. However, comparative studies using a placebo group are needed.

Updates and Insights in the Diagnosis and Management of DRESS Syndrome.

Purpose of ReviewTo provide updates on recent advances in the diagnosis and management of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.Recent FindingsThe number of identified HLA allele associations with DRESS continues to grow. There is increasing evidence indicating viral infection, reactivation, and cross-reactivity may play key roles in disease. Translational work illuminated JAK/STAT activation in recalcitrant disease. There is expanding recognition of rapid-onset DRESS resulting from specific drugs.SummaryDRESS is a severe form of adverse drug reaction with potential for significant morbidity and mortality. Recent research advances may improve clinical care. HLA screening can now be performed to prevent disease in susceptible patients and may help identify culprit drugs in the near future. Viral testing should be performed on every patient, and if positive, patients potentially treated with antiviral therapy. JAK inhibitors may be an effective treatment option for DRESS. Early onset of disease relative to drug exposure should not exclude the diagnosis of DRESS.

Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate

BackgroundDrug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an important adverse reaction caused by a few drugs. Reactivation of human herpesvirus 6 (HHV-6) is known to be associated with its pathogenesis. DIHS occasionally manifests as pulmonary lesions with a variety of imaging findings.Case presentationAn 83-year-old woman started taking minodronic acid hydrate 5 years before admission. She noticed a generalized skin rash 44 days before admission and started oral betamethasone-d-chlorpheniramine maleate combination tablets for allergic dermatitis. She developed a fever and cough in addition to the rash, and was referred to our hospital. Laboratory data showed a high level of eosinophils and liver and biliary enzymes. Computed tomography (CT) studies revealed bilateral diffuse ground-glass opacities with ill-defined centrilobular nodules from the central to peripheral regions of the lungs. Transbronchial lung cryobiopsy specimens showed that lymphocyte infiltration was observed in the alveolar walls and fibrinous exudates and floating macrophages in the alveolar lumina. Immunohistochemistry of biopsy specimens showed more CD4+ lymphocytes than CD8+ lymphocytes, while few Foxp3+ lymphocytes were recognized. The serum anti-HHV-6 immunoglobulin G titer increased at 3 weeks after the first test. Based on these findings, we diagnosed her with DIHS. We continued care without using corticosteroids since there was no worsening of breathing or skin condition. Eventually, her clinical symptoms chest CT had improved. Minodronic acid hydrate was identified as the culprit drug based on the positive results of the patch test and drug-induced lymphocyte stimulation test.ConclusionsWe described the first case of DIHS caused by minodronic acid hydrate. Lung lesions in DIHS can present with bilateral diffuse ground-glass opacities and ill-defined centrilobular nodules on a CT scan during the recovery phase. Clinicians should be aware of DIHS, even if patients are not involved with typical DIHS/DRESS-causing drugs.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Associated with Enoxaparin Therapy in a Pediatric Patient

Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare drug hypersensitivity reaction characterized by diffuse skin eruption with systemic symptoms (fever, lymphadenopathy, elevated transaminases, leukocytosis with eosinophilia and atypical lymphocytes) which develops 2-6 weeks after exposure to inciting medications. Clinical presentation is variable and nonspecific. DRESS syndrome is more common in adults, can be life threatening, and is most commonly seen with antibiotics, antiepileptic drugs, and allopurinol. An inciting drug is identified in the majority of cases. DRESS syndrome has been described rarely in association with Vitamin K antagonists and direct oral anticoagulants. In an in-depth examination of existing literature, there are only two reported cases of DRESS syndrome associated with enoxaparin therapy, both in adult patients and no reports of pediatric DRESS syndrome secondary to anticoagulants. We present a case of a pediatric patient with DRESS syndrome associated with enoxaparin therapy.Case Report: A previously healthy 11-year-old female was admitted with sepsis secondary to osteomyelitis and periosteal abscess of the left lower extremity, as well as MRSA bacteremia. The patient was initiated on clindamycin and vancomycin for treatment of underlying infections. A left lower extremity ultrasound with doppler was obtained due to lower extremity swelling and demonstrated an acute deep venous thrombus of the left popliteal vein. She was initiated on a heparin drip and subsequently transitioned to enoxaparin one week later. Several weeks into her hospital course (two weeks after initiation of enoxaparin), she developed facial swelling, a generalized morbilliform rash, and diffuse lymphadenopathy both on exam and abdominal imaging. She continued to have persistent fevers despite multiple washouts of the extremity, appropriate antimicrobial coverage, and negative blood cultures. Liver enzymes concurrently increased (AST 362 IU/L (normal 5-60 IU/L), ALT 371IU/L (normal <35 IU/L) at peak) with development of clinical symptoms. Eosinophilia was not present on initial CBC, though she subsequently developed mild eosinophilia (1.1 K/ul at peak). HHV6, CMV, and EBV serologies were all negative. Skin biopsy was performed and was consistent with a drug eruption. Using the RegiSCAR criteria for DRESS syndrome, this constellation of labs and symptoms indicate a definite case of DRESS syndrome with a score of 6 (final score >5 is needed for a definite case). The patient was started on treatment with high-dose steroids. Clindamycin and vancomycin were both discontinued due to their known association with DRESS syndrome. She was transitioned to doxycycline, however, no improvement in rash, fevers, or liver enzymes was seen over the course of five days. Given this, enoxaparin was transitioned to apixaban. The patient improved with resolution of rash, fevers, and improvement of liver enzymes and eosinophilia within a few days of the discontinuation of enoxaparin.Conclusion: The diagnosis of DRESS syndrome can be challenging due to its nonspecific presentation, particularly in pediatric patients where symptoms can overlap with common viral syndromes and Kawasaki disease, and therefore requires a high index of suspicion. Though children with DRESS syndrome have a better prognosis than adults, prompt recognition and treatment is required to limit morbidity and mortality. In pediatric patients receiving treatment with enoxaparin, DRESS syndrome should be included on the differential for those who develop persistent fevers, lymphadenopathy, rash, transaminitis and/or eosinophilia, and discontinuation of enoxaparin should be considered. DisclosuresWeyand: Takeda: Consultancy; Genentech: Consultancy; Novo Nordisk: Research Funding; Sanofi: Consultancy, Research Funding.

DRESS Syndrome Due to Cefdinir Mimicking Superinfected Eczema in a Pediatric Patient

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome shares many clinical features with viral exanthems and may be difficult to diagnose in the setting of atopic dermatitis in which children may have baseline eosinophilia from an atopic diathesis.

Statin-induced drug reaction with eosinophilia and systemic symptoms

Statin drugs are widely prescribed in clinical practice. Common adverse effects include elevated liver enzyme levels and muscle pain.1 Although rare severe adverse reactions such as diffuse myositis and rhabdomyolysis occur,2 these risks are outweighed by the effectiveness of statin medications in preventing ischemic cardiovascular and cerebrovascular diseases. Severe multisystemic hypersensitivity drug reactions to statins are uncommon.3,4 Here, we describe a recurrent life-threatening hypersensitivity drug reaction consistent with drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) manifested by skin rash, transaminitis, elevated muscle enzyme levels, and acute interstitial nephritis after initiation of rosuvastatin, which resolved after its discontinuation.

The autochthonous cases of acute opisthorchiasis in the Moscow region

Acute stages of parasitic diseases are rare diagnosed and therefore, clinicians have limited knowledge of their clinical features. We describe five autochtnonous acute cases of opisthorchiasis in Moscow region acquired from eating raw ides (L. idus). The most frequent clinical symptoms were febrile, eosinophilic syndrome with cholestasis. The patients were positive for IgG antibodies to Opisthorchis felineus. Eggs of O. felineus were found in one patient. As egg production O. felineus starts 1 month after exposure and opisthorchiasis cases in Moscow region have low numbers of worms, the sensitivity of microscopy is low. Therefore we consider opisthorchiasis in all patients of unexplained acute fever, pain in upper right abdominal quadrant, and eosinophilia with cholestasis, when patients confirm the ingestion of raw fish. We recommend one day of praziquantel 25 mg/kg TID to patients infected with O. felineus. In previous publications describing the autochtnonous cases of opisthorchiasis in Moscow region the authors supposed that cases of local infection will be found again in Moscow region and this is just a matter of time. The cases reported here confirm that this infection is endemic in Moscow region. The local people living close to rivers especially those who eat raw fish are at risk of infection O. felineus. There is a clear need to undertake special studies pertaining to the ways of promoting people living in Moscow region become aware of opisthorchiasis and to be motivated in preventive measures and treatment.

DRESS SYNDROME

TOPIC: Allergy and Airway TYPE: Global Case Reports INTRODUCTION: Severe cutaneous adverse reactions (SCARs) are a group of disorders caused by a drug-induced hypersensitivity response. One important type of SCAR is Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) – a complex, multisystem, and possibly life-threatening drug response. Here we report a case of Lamictal associated DRESS which is rare and seldom reported. CASE PRESENTATION: A 44-year-old Caucasian female with past medical history significant for COPD on 3 liters home oxygen, bipolar disorder, recurrent mucocutaneous infections and seizures. She has been on Lamictal for treatment of seizures. Patient over last 2 years was admitted in hospital about 5 times with episodes of cough, wheezing and sob. she also had recurrent cutaneous abcesses. Her physician exam was consistent with middle aged female, with diffuse wheezing and skin lesions. Her historical chest x-ray has shown ongoing lll infiltrates, and so it was confirmed with cat scan showing diffuse GGO infiltrates more in left lower lobe. she was investigated with hypersensitivity pneumonitis panel, fungal serology, strep, legionella antigen which was negative. she had slightly lower IGG level. She kept on having these episodes inspire of optimal therapy . Only notable abnormal findings in her laboratory was elevated eosinophils count, with normal IGE level. Her initial count was 19% with sputum eosinophils. AS diagnosis of exclusion DRESS syndrome- associated with lamictal was diagnosed, which is quite rare and so therapy was discontinued and switched to alternative anti seizure therapy. Follow up in 2 months showing eosinophils count dropping to 3% with no recurrent symptoms. DISCUSSION: Several mechanisms are implicated as part of the pathogenesis underlying DRESS syndrome:. Most commonly DRESS is classified as a type IV delayed hypersensitivity reaction. Organ involvement in DRESS is due to eosinophil infiltration of the tissue causing damage. Liver is commonest organ affected followed by kidney and then lungs. Lung involvement can present with symptoms of dyspnea, cough, and/or pleuritic pain, pneumonia, interstitial pneumonitis, pulmonary nodules, or even acute respiratory distress syndrome (ARDS) in severe cases he European Registry for Severe Cutaneous Adverse Reactions (RegiSCAR) is an internationally recognized aid for which provides a clear definition and criteria for diagnosing DRESS syndrome. Though there is reasonable controversy exist about the diagnosis. The most important step in treatment of DRESS syndrome is prompt recognition and withdrawal of the offending drug. Systemic corticosteroids are generally considered the mainstay of therapy. immunosuppressive therapy should be used cautiously. CONCLUSIONS: DRESS is rare syndrome but should be included in the differential diagnosis for patients with peripheral eosinophilia and a medication history with a drug known to be a culprit for it. REFERENCE #1: Cho, Y.-T., C.-W. Yang, and C.-Y. Chu, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System. International journal of molecular sciences, 2017. 18(6): p. 1243. REFERENCE #2: Bocquet, H., M. Bagot, and J.C. Roujeau, Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Semin Cutan Med Surg, 1996. 15(4): p. 250-7. REFERENCE #3: Taweesedt, P.T., et al., Pulmonary Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review. Biomed Res Int, 2019. 2019: p. 7863815. DISCLOSURES: No relevant relationships by Abhijit Raval, source=Web Response no disclosure on file for Dhruv Raval

Less Known Gastrointestinal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of the Literature.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life threatening severe cutaneous drug reaction. Most patients develop eosinophilia, a rash, a fever, lymphadenopathy and variable visceral organ involvement 2–6 weeks following exposure to the inciting medication. Unlike other severe cutaneous drug reactions, internal organ involvement that leads to high mortality is a unique feature of DRESS syndrome. While the liver is the most common internal organ involved, literally every other visceral organ can be affected in this syndrome. The lesser-known gastrointestinal manifestations of this syndrome include esophagitis, gastritis, enteritis, colitis, pancreatitis and a late autoimmune sequela due to pancreatic injury such as fulminant type 1 diabetes mellitus, autoimmune type 1 diabetes mellitus and type 2 diabetes mellitus. While these entities are less common, they are associated with equally severe complications and adverse patient outcomes. In this review, we synthetize data on these rare manifestations using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The liver, the most common visceral organ involved, has been described as part of DRESS elsewhere and is not included in the scope of this article.

Specific features of amoxicillin-associated Drug Reaction with Eosinophilia and Systemic Symptoms syndrome: a nationwide study.

Growing evidence indicates that amoxicillin induces herpesvirus replication in vitro. As these play a central pathophysiological role in Drug Reaction with Eosinophilia and Systemic Symptoms syndrome (DRESS), amoxicillin could present with specific DRESS features. To characterize the onset patterns of amoxicillin-associated DRESS. All cases of DRESS (Kardaun score ≥4) involving amoxicillin and reported in the French Pharmacovigilance Database between January 1, 2004 and November 30, 2019 were included. Onset circumstances for these cases were categorized considering the onset delay from amoxicillin initiation, and the presence of concomitant medications with a compatible time to onset. A total of 146 probable cases or definite cases of DRESS were included. Three onset circumstances were identified: (i) 'amoxicillin clear culprit' where amoxicillin was the sole suspect drug or when concomitant drugs of compatible time to onset were not reported to cause DRESS (n = 62); (ii) 'amoxicillin possible culprit' in the presence of other potentially culprit drugs in addition to amoxicillin (n = 44) and (iii) 'flare' where amoxicillin, used after DRESS onset, induced flare-up reactions (n = 40). The median time to onset was 5 days (IQR 2-11) in 'clear culprit', and 18 days (IQR 7-26) in 'possible culprit' cases. In 'flare' cases, the median latency between amoxicillin initiation and flare-up reactions was 3 days (IQR 2-5). Amoxicillin can induce DRESS with a specific early onset and exacerbate DRESS from another drug.

An investigation into the avoidability of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rising morbidity amongst hospitalized patients. Whilst clinical protocols for the management of individual DRESS cases have been well established, determination of potential prevention of these cases by utilizing novel “avoidability” tools has remained unexplored. This retrospective study reviewed records of patients who presented to the emergency department of Weill Cornell Medicine-affiliated Hamad General Hospital, Doha Qatar with suspected DRESS syndrome. These cases were independently adjudicated (utilizing the RegiSCAR, and JSCAR tools) as DRESS-drug pairs by a team of two clinical pharmacists and two General Physicians. They were then rated for potential avoidability with the Liverpool adverse drug reactions avoidability tool (LAAT) by the same team of raters. A total of 16 patients satisfied RegiSCAR criteria for DRESS syndrome. The mean age of the study population was 41.5 years (SD ± 13.3). The study population was predominantly male (n = 12; [75%]). The median latent period from drug ingestion to clinical presentation was 14 days (interquartile range [IQR] 6.5, 29). The median RegiSCAR and J-SCAR scores were 6 (IQR 5, 6.8), 5 (IQR 4, 5.8) respectively. Utilizing the LAAT, about 60% of the DRESS syndrome-drug pairs were rated as “avoidable” (“probable” or “definite”). The overall Krippendorf’s alpha with the LAAT was 0.81 (SE 0.10, CI 0.59–1.00); with an intraclass correlation coefficient (ICC) of 0.90 (CI 0.77, 0.96.). In a randomly selected cohort of DRESS syndrome-drug pairs, a significant proportion was potentially avoidable (“possibly” and “definitely”) utilizing the LAAT. This will need validation by larger sample-sized prospective studies utilizing the updated LAAT proposed by this study.