Viral rashes mimicking drug reaction with eosinophilia and systemic symptoms syndrome in children after β-lactams intake: a diagnostic challenge

Dondi, Arianna; Parladori, Roberta; Mori, Francesca; Liccioli, Giulia; Bassi, Andrea; Lanari, Marcello; Patrizi, Annalisa; Neri, Iria

doi:10.1007/s00431-021-04010-5

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…Tese mimickers include, but are not limited to, toxic shock syndrome, Stevens-viral infections, infectious mononucleosis particularly after amoxicillinpseudolymphoma) . [1,19].…”

Section: Discussionmentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome in a Child with Cystic Fibrosis

Abushahin

Toma

Hamad

et al. 2023

Case Reports in Immunology

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Background. Drug reaction with eosinophilia and systemic symptoms (DRESSs) syndrome is an idiosyncratic drug-induced reaction that rarely occurs in children but can lead to serious complications. It manifests most commonly with fever, extensive skin eruptions, and eosinophilia. Symptoms typically develop two to six weeks after the initiation of the inciting drug. Visceral organ involvement especially the liver can also occur and if not recognized early and the inciting drug is not stopped immediately, it can lead to liver failure. Therefore, early diagnosis is important but can be very challenging because of disease rarity, lack of a diagnostic test, and its overlap with other common pediatric allergic and infectious conditions. Case Presentation. A 2.5-year-old boy with known diagnosis of cystic fibrosis, bilateral bronchiectasis, pancreatic insufficiency, and chronic airway colonization with Pseudomonas aeruginosa was admitted to our hospital with acute pulmonary exacerbation of CF lung disease. He was treated with intravenous piperacillin-tazobactam and intravenous amikacin in addition to airway clearance. On day 18 of treatment, the patient developed high grade fever followed by diffuse erythematous and pruritic maculopapular rash. Blood tests showed high eosinophilia, high C-reactive protein (CRP), and high liver enzymes levels. The clinical features and the laboratory findings were consistent with the DRESS syndrome. Therefore, all antibiotics were discontinued. Progressive resolution of the symptoms was observed within two days. Laboratory abnormalities were also normalized in the follow-up clinic visit 4 months later. Conclusion. Our case demonstrates the importance of early recognition of the DRESS syndrome in children who develop fever and skin rashes with eosinophilia while undergoing long-term antibiotic treatment. Prompt discontinuation of the offending drug is the cornerstone therapy and results in the resolution of symptoms and prevention of serious complications.

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“…Tese mimickers include, but are not limited to, toxic shock syndrome, Stevens-viral infections, infectious mononucleosis particularly after amoxicillinpseudolymphoma) . [1,19].…”

Section: Discussionmentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome in a Child with Cystic Fibrosis

Abushahin

Toma

Hamad

et al. 2023

Case Reports in Immunology

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“…The symptoms generally begin 2-8 weeks after drug introduction, may persist for several weeks after drug suspension, and may cause a significant diagnostic challenge. In children, the most common clinical presentation is fever, a maculo-papular rash, and a variable degree of lymphadenopathy with associated eosinophilia, which is common but may be absent; additionally, prodromal symptoms mimicking mild viral infections may be present (4,6). The current literature does not show significant differences in the clinical presentation between children and adults (34).…”

Section: Clinical Manifestationsmentioning

confidence: 91%

“…Neuropsychiatric disorders are the most common comorbidities, consistently with antiepileptics being the main triggers (10). In the general population, the overall mortality rate is 10%; in children, it is estimated to be around 5.4% (4,11).…”

Section: Incidence Etiology and Risk Factorsmentioning

confidence: 99%

“…The Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare but severe, potentially fatal, idiosyncratic, adverse drug reaction with cutaneous and systemic manifestations (1). It is characterized by widespread skin involvement with mucocutaneous and multisystem involvement, fever, lymphadenopathy, hematologic abnormalities (eosinophilia, mononucleosis-like atypical lymphocytes), and viral reactivation (2,3); furthermore, prodromes mimicking viral infections may occur (4). The first reports of this syndrome date to the 1950s under different names, e.g., "anticonvulsant hypersensitivity syndrome, " "drug-induced hypersensitivity syndrome, " "drug-induced delayed multiorgan hypersensitivity syndrome" (5), or "drug-induced pseudolymphoma" (6), but it was Bocquet et al (6) who first reported it in 1996 as the "DRESS syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review

et al. 2023

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Despite being rare, the Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a serious, possibly fatal condition that may affect both adults and children who may be also burdened by delayed sequelae. It is an adverse drug reaction characterized by widespread skin involvement, fever, lymphadenopathy, visceral involvement, and laboratory abnormalities (eosinophilia, mononucleosis-like atypical lymphocytes). It is more frequently triggered by anticonvulsants, sulphonamides, or antibiotics, the latter being responsible for up to 30% of pediatric cases. The disease typically develops 2–8 weeks after exposure to the culprit medication, with fever and widespread skin eruption; mild viral prodromes are possible. Unfortunately, diagnosis is challenging due to the absence of a reliable test; however, a score by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) allows to classify suspect patients into no, possible, probable, or definite DRESS cases. Moreover, rapid-onset DRESS syndrome has been described in recent years. It affects children more often than adults and differs from the most common form because it appears ≤15 days vs. >15 days after starting the drug, it is usually triggered by antibiotics or iodinated contrast media rather than by anticonvulsants and has a higher presence of lymphadenopathy. Differential diagnosis between rapid-onset antibiotic-driven DRESS syndrome, viral exanthems, or other drug eruptions may be challenging, but it is mandatory to define it as early as possible to start adequate treatment and monitor possible complications. The present review reports the latest evidence about the diagnosis and treatment of pediatric DRESS syndrome.

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“…Debido a la heterogeneidad de la presentación clínica, deben excluirse enfermedades con cuadro similar. Estas posibilidades incluyen al síndrome de shock tóxico, el síndrome de Stevens-Johnson e infecciones víricas como la mononucleosis infecciosa, en particular tras el pseudolinfoma inducido por amoxicilina [1, 19].…”

Section: Discusión Y Conclusionesunclassified

Síndrome de reacción a fármaco con eosinofilia y síntomas sistémicos en un niño con fibrosis quística

Abushahin,

Toma,

Hamad

et al. 2023

Kompass Neumol

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Antecedentes: El síndrome de reacción a fármacos con eosinofilia y síntomas sistémicos (DRESS) es una reacción idiosincrásica inducida por fármacos que rara vez se produce en niños, pero que puede dar lugar a complicaciones graves. Se manifiesta sobre todo con fiebre, erupciones cutáneas extensas y eosinofilia. Los síntomas suelen aparecer entre dos y seis semanas después de la administración del fármaco desencadenante. También pueden verse afectados los órganos viscerales, especialmente el hígado, y si no se detecta de forma temprana y no se interrumpe de inmediato la administración del fármaco desencadenante, puede producirse insuficiencia hepática. Por tanto, un diagnóstico temprano es importante, aunque puede ser muy difícil debido a la rareza de la enfermedad, la falta de una prueba diagnóstica y su similitud con otras afecciones alérgicas e infecciosas pediátricas comunes. Presentación del caso: Un niño de 2.5 años con diagnóstico conocido de fibrosis quística, bronquiectasias bilaterales, insuficiencia pancreática y colonización crónica de las vías respiratorias por Pseudomonas aeruginosa ingresó en nuestro hospital con una exacerbación aguda de enfermedad pulmonar por FQ. Se le trató con piperacilina-tazobactam y amikacina, ambos por vía intravenosa, y se despejaron las vías respiratorias. En el día 18 de tratamiento, el paciente desarrolló fiebre elevada seguida de erupción maculopapular eritematosa y pruriginosa difusa. Los análisis de sangre mostraron eosinofilia, proteína C reactiva (CRP) elevada y niveles altos de enzimas hepáticas. Las manifestaciones clínicas y los resultados de laboratorio fueron compatibles con el síndrome DRESS. Por tanto, se suspendieron todos los antibióticos. Se observó una resolución progresiva de los síntomas en dos días. Las anomalías de laboratorio también se normalizaron en la visita clínica de seguimiento cuatro meses después.

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Viral rashes mimicking drug reaction with eosinophilia and systemic symptoms syndrome in children after β-lactams intake: a diagnostic challenge

Cited by 8 publications

References 13 publications

Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome in a Child with Cystic Fibrosis

Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome in a Child with Cystic Fibrosis

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review

Síndrome de reacción a fármaco con eosinofilia y síntomas sistémicos en un niño con fibrosis quística

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