Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome)

Silva, Soraia Aparecida da; Figueiredo, Mariana Maciel Pereira de; Neto, Lauro Carneiro; Reiss, Débora B; Damásio, Mariana Amaranto de Souza

doi:10.1590/1806-9282.62.03.227

Cited by 8 publications

(9 citation statements)

References 11 publications

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“…3 Another case of DRESS was reported in a 20 years old Brazilian female who took valproate and haloperidol. 19 An adolescent with symptoms of mania, developed DRESS syndrome when valproate was combined with olanzapine. 20 A 60 years old Iranian male developed DRESS syndrome with prophylactic valproate (1000 mg/day) therapy, after subarachnoid haemorrhage and concomitant insulin therapy for diabetes.…”

Section: Discussionmentioning

confidence: 99%

A probable case of sodium valproate monotherapy induced drug reaction with eosinophilia and systemic symptoms syndrome: a case report in Indian population

Arunnair¹,

Kumaraswamy

Ramesh

2020

Int J Basic Clin Pharmacol

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity syndrome most commonly caused by anti-epileptics like carbamazepine, phenytoin. It usually manifests as maculopapular rash, fever, eosinophilia, generalized lymphadenopathy, hepatitis, atypical lymphocytosis, and leucocytosis with the involvement of other organs. Valproate, a broad-spectrum antiepileptic, also used in bipolar disorders and migraine prophylaxis, is generally well tolerated. To date, very few cases of valproate monotherapy induced DRESS syndrome have been reported worldwide and here we are reporting one such rare case in a 72 years old Indian woman with a history of generalised tonic convulsions. The patient was classified as a ‘probable’ case of DRESS syndrome using the WHO-UMC criteria and Naranjo scale. Discontinuation of the offending medication and treatment with intravenous (IV) fluids, antihistamines, and steroids helped in recovery of the patient. Healthcare practitioners must be aware of valproate monotherapy induced DRESS syndrome and take effective measures to avoid severe side effects.

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Section: Discussionmentioning

confidence: 99%

A probable case of sodium valproate monotherapy induced drug reaction with eosinophilia and systemic symptoms syndrome: a case report in Indian population

Arunnair¹,

Kumaraswamy

Ramesh

2020

Int J Basic Clin Pharmacol

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“…Other modalities of treatment such as cyclosporine, N-acetylcysteine and intravenous immunoglobulins may also be used, but the evidence is lacking [7,15-17]. Family members of the patients should be informed of the diagnosis DRESS as it is inheritable [18-19].…”

Section: Discussionmentioning

confidence: 99%

A Fatal Case of Vancomycin Associated Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome in a Septuagenarian

Gangireddy

Sarao

Shrimanker

et al. 2019

Cureus

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially life-threatening multi-system disorder with a mortality rate of up to 10%, due to severe hypersensitivity drug reaction involving the skin and multiple internal organ systems. We emphasize the increasing prevalence of DRESS syndrome secondary to vancomycin use. A 79-year-old woman presented to the hospital with complaints of right upper quadrant pain, intense pruritis, and jaundice of one-week duration. She was on vancomycin and cefepime for six weeks after a wound infection, and both the medicines were withheld a week ago due to the increasing creatinine. She was afebrile with a pulse-94/min, blood pressure-92/46 mm of Hg, and respiratory rate-14/min. She had scleral icterus, diffuse maculopapular rash, generalized edema, right upper quadrant tenderness, and a positive Murphy’s sign. Investigations revealed hemoglobin-10.5 gm/dl, white blood cell count-16.0 K/uL, peripheral eosinophil count-1730 K/uL, alkaline phosphatase-2742 U/L, aspartate transaminase-612 U/L, alanine transaminase-674 U/L, total bilirubin-14.2 mg/dl with a direct component of 9.5mg/dl, blood urea nitrogen-64 mg/dl, creatinine-5.01 mg/dl, glomerular filtration rate-8 ml/min and vancomycin trough level-10.8 mcg/ml. Imaging studies were unremarkable. The renal function improved after high dose steroids, N-acetylcysteine and withdrawal of vancomycin, but the progression of liver failure continued. Eventually, she passed away due to multiorgan failure. Vancomycin is a rare drug to cause DRESS syndrome with 31 cases reported to date. Early recognition of this condition can hasten proper treatment and recovery. Further research on the association of vancomycin trough levels and DRESS syndrome needs to be conducted.

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“…This patient had insulin at the same time for his diabetes [17] . Another case reported a 20-year-old Brazilian female with DRESS after a treatment with VAP and haloperidol [18] . Our patient took warfarin for his previous ischemic stroke and atrial fibrillation for a long time, while he took VPA for epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Drug-induced hypersensitivity syndrome caused by valproic acid as a monotherapy for epilepsy: First case report in Asian population

Hong

Suolang

et al. 2017

Epilepsy & Behavior Case Reports

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Valproic acid (VPA) is a broad-spectrum antiseizure drug used for a variety of clinical conditions, such as epilepsy and mood disorders. Drug-induced hypersensitivity syndrome (DRESS) accompanied by hyponatremia, thrombocytopenia, hypoalbuminemia and elevated aminotransferase has never been reported as an adverse effect of VPA monotherapy during titration for epilepsy in Asian population. Hereby, we present the case of a 73-year-old Chinese male who suffered from DRESS and other complications two weeks after initiating VPA treatment for epilepsy. Understanding the risk associated with VPA-induced DRESS, and taking effective measures to avoid the severe side effects are necessary.

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Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome)

Abstract: The approach and discussion of the topic are of paramount importance, in view of the potential lethality of this treatable syndrome. Recognizing the occurrence of DRESS syndrome and starting treatment as soon as possible is crucial to reduce the risk of mortality and improve prognosis.

Cited by 8 publications

References 11 publications

A probable case of sodium valproate monotherapy induced drug reaction with eosinophilia and systemic symptoms syndrome: a case report in Indian population

A probable case of sodium valproate monotherapy induced drug reaction with eosinophilia and systemic symptoms syndrome: a case report in Indian population

A Fatal Case of Vancomycin Associated Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome in a Septuagenarian

Drug-induced hypersensitivity syndrome caused by valproic acid as a monotherapy for epilepsy: First case report in Asian population

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