An unusual case of DRESS syndrome due to leflunomide

Vaish, Arvind Kumar; Tripathi, Anil Kumar; Gupta, Lokesh Kumar; Jain, Nityanand; Agarwal, Abhishek; Verma, Sudhir Kumar

doi:10.1136/bcr.06.2011.4330

Cited by 9 publications

(7 citation statements)

References 7 publications

(7 reference statements)

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“…[4] A similar case was reported by Vaish, et al [5,6] in which the authors reported a case of DRESS syndrome with severe exfoliative dermatitis with acute hepatitis associated with intake of lefl unomide.…”

Section: Discussionmentioning

confidence: 50%

Drug reaction with eosinophilia and systemic syndrome: Systemic drug reaction

Sharma

Gokhale

Lokwani

et al. 2013

Int J Med Public Health

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Section: Discussionmentioning

confidence: 50%

Drug reaction with eosinophilia and systemic syndrome: Systemic drug reaction

Sharma

Gokhale

Lokwani

et al. 2013

Int J Med Public Health

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“…It appears from published reports that DRESS or hypersensitivity reactions are reported more commonly in Indians from the sub-continent than European-Americans. [11][12][13][14] In the US DILIN experience, risks of SJS/ TEN are higher among African-Americans than among other ethnic and racial groups. 15 The phenotypic differences suggest that genetic, pharmacokinetic, and environmental factors are important factors in the pathophysiology of lefluonomide-induced DILI.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast in the patients from the USA, DRESS or SJS/TEN did not occur, despite a comparable severity of liver injury in both the groups. It appears from published reports that DRESS or hypersensitivity reactions are reported more commonly in Indians from the sub‐continent than European‐Americans 11‐14 . In the US DILIN experience, risks of SJS/TEN are higher among African‐Americans than among other ethnic and racial groups 15 .…”

Section: Discussionmentioning

confidence: 99%

Leflunomide‐induced liver injury: Differences in characteristics and outcomes in Indian and US registries

Devarbhavi

Ghabril

Barnhart

et al. 2022

Liver International

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Background Leflunomide, a disease‐modifying anti‐rheumatic drug, has been associated with elevations of serum aminotransferases. Herein, we describe the clinical, laboratory features and outcomes of 17 patients with leflunomide/teriflunomide hepatotoxicity from two large drug‐induced liver injury (DILI) registries. Methods Consecutive, adjudicated cases of leflunomide (n = 16)‐or teriflunomide (n = 1)‐related DILI from a single centre in Bangalore, India and the multicentre US Drug‐Induced Liver Injury Network (DILIN) were reviewed. Results Nine (0.8%) of the 1070 Indian patients and 8 (0.5%) of the 1400 DILIN patients fulfilled the criteria for DILI because of leflunomide‐ or teriflunomide. 89% of the Indian cases were women and all were associated with severe cutaneous adverse reaction (SCAR) and a median drug latency of 49 days, whereas 37.5% of the DILIN cases were female, none exhibited SCAR and the median drug latency was 166 days. Hepatocellular injury (70%) was more common in women than men (92% vs. 20%) and was associated with younger mean age (41 vs. 59 years), higher peak INR (2.3 vs. 1.2) and higher mortality (58% vs. 0%). Mortality was observed in six patients from India (2 of the three with myocarditis) and one received liver transplantation from the USA. Conclusion Leflunomide‐induced liver injury is predominantly hepatocellular. Leflunomide hepatotoxicity is more likely accompanied by SCAR, a short latency and a higher mortality in the Indian cohort, with a predominance of females, compared to US DILIN patients. The differences in skin involvement, immunoallergic features and outcomes among subjects from India vs. the USA suggest that genetic or environmental factors are important in the pathogenesis of liver injury.

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“…While gastrointestinal events such as nausea and diarrhea are the most reported adverse effects of LEF therapy [7], DRESS syndrome is rarely reported. A literature review of PubMed revealed only nine previous cases of LEF-induced DRESS syndrome have been reported [8][9][10][11][12], suggesting that the rate of LEF-induced DRESS syndrome is significantly less than the average incidence.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Leflunomide-Induced Drug Reaction With Eosinophilia and Systemic Symptom (DRESS) Syndrome Despite Prolonged Steroid Taper: A Case Report

Gayfield¹,

Busken²,

Mansur³

2022

Cureus

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characterized primarily by nonspecific systemic symptoms such as fever, a classical rash, and eosinophilia. While this is an adverse reaction more often related to medications such as anticonvulsants, many drugs have been reported to be implicated in this event. We report a case of a 35-year-old male who developed DRESS syndrome within one month of beginning leflunomide therapy. Despite treatment with a prolonged steroid taper, he developed a flare-up with transaminitis less than two months after his initial hospitalization. Our patient was managed with steroid pulse therapy and cyclosporine, which resulted in an improvement of symptoms and transaminitis. To our knowledge, only nine previous cases of leflunomideinduced DRESS syndrome have been previously reported.

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An unusual case of DRESS syndrome due to leflunomide

Cited by 9 publications

References 7 publications

Drug reaction with eosinophilia and systemic syndrome: Systemic drug reaction

Drug reaction with eosinophilia and systemic syndrome: Systemic drug reaction

Leflunomide‐induced liver injury: Differences in characteristics and outcomes in Indian and US registries

Recurrent Leflunomide-Induced Drug Reaction With Eosinophilia and Systemic Symptom (DRESS) Syndrome Despite Prolonged Steroid Taper: A Case Report

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