DRESS: clinicopathological features of 10 cases from an University Hospital in São Paulo

Abstract

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms is a severe form of drug-induced reaction with multiorgan involvement. OBJECTIVES: The aim of this study is to evaluate the epidemiological, clinical and pathological features and prognosis of this drug reaction among patients seen at a dermatology service. METHOD: Retrospective review of medical records of ten patients diagnosed with drug reaction with eosinophilia and systemic symptoms at the Federal University of São Paulo, from august 2008 to may 2011. RESULTS: Phenytoin was the leading cause of drug reaction with eosinophilia and systemic symptoms in our cases, followed by allopurinol. Abnormal liver function tests were observed in 7 patients and renal function impairment in 2 patients. In all cases, patients were hospitalized and the culprit drug was withdrawn. The main treatment was systemic corticosteroid. Drug reaction with eosinophilia and systemic symptoms resulted in death in 2 cases. The causes of death were septic shock and hepatic failure. CONCLUSION: Our mortality rate of 20%, supports that drug reaction with eosinophilia and systemic symptoms is a severe form of drug-induced reaction and must be recognized by all dermatologists.

Drug reaction with eosinophilia and systemic symptoms: a clinicopathological study of six cases at a teaching hospital in midwestern Brazil

“…Patients were predominantly male, as observed in other small series investigated elsewhere, but in contrast with studies involving a large number of patients, in which females predominated . This variability, however, may have been circumstantial.…”

“…Phenytoin was the leading cause of DRESS/DIHS, albeit to a lesser extent than in other studies . Several investigations have identified aromatic anticonvulsants as the drugs that most often lead to DRESS/DIHS, while other studies conducted in Taiwan revealed allopurinol as the most commonly implicated drug …”

DRESS sendromlu 11 olgunun klinik özelliklerinin incelenmesi

“…Bu çalışmada takip edilen hastaların tamamında sorumlu ilaç aromatik antikonvülzanlardı. Bizim hastalarımıza benzer şekilde Brezilya'da da fenitoinin en sık sorumlu ilaç olduğu bildirilmiştir 5 . Yang ve ark.…”

“…Deri belirtilerinin spektrumu çok geniştir. Sendromun kliniği tam olarak geliştiğinde, şiddetli mukokutanöz düküntüye ek olarak, ateş, lenfadenopati (LAP), hematolojik bozukluklar ve iç organ tutulumları görülebilir 4,5 . Farklı organ tutulumları ve deri bulgularının çeşitliliği nedeniyle DRESS sendromunun tanısı zordur 2,6 .…”

DRESS Syndrome After Phenytoin Use: A Case Report

“…çalışmasında da DRESS sendromuna en sık neden olan ilacın fenitoin olduğu bulunmuştur. 9 Ülkemizde de Emre ve ark'nın 11 olguluk DRESS sendromu serilerinde tüm hastalarında etyolojik ajanın fenitoin olduğu bulunmuştur. 10 Bizim olgumuzda da literatür desteklenir şekilde DRESS sendromu fenitoin kullanımı sonrası meydana gelmiştir.…”