Complicated Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome History in a 14-Year-Old

Abstract

Patient: Female, 14-year-old Final Diagnosis: DRESS syndrome Symptoms: Blurry vision and dizziness • erythematous papular rash Medication: — Clinical Procedure: — Specialty: Allergology Objective: Unknown ethiology Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity reaction that can result in a severe cutaneous adverse drug reaction (SCAR). It is a rare and potentially life-threatening condition that occurs after exposure to sulfonamides, antibiotics, or antiepileptics. Its incidence in children is not established; however, the mortality rate is documented at approximately 10%. DRESS syndrome is believed to result from an interaction between multiple factors, including genetics, abnormalities of metabolism, and reactivation of certain herpes family viruses including EBV and HHV-6. The classic presentation includes fever, rash, and lymphadenopathy. Symptoms begin approximately 3 to 8 weeks after exposure to the offending agent. Case Report: We present a unique case of DRESS syndrome in a 14-year-old girl occurring after the ingestion of minocycline and amoxicillin-clavulanic acid (amoxicillin). Identification of the offending agent was complicated by the patient having been on multiple antibiotics within a short timeframe of the initial presentation of symptoms. In addition to swelling and pruritus, the patient experienced vision problems due to papilledema with bilateral hemorrhage. The treatment course was further complicated by a decrease in kidney function, requiring the patient’s medication regimen to be adjusted accordingly. Conclusions: This is a unique case of DRESS syndrome demonstrating the potential influence of certain viruses on the severity of its presentation. This case also highlights the need to adjust the steroid regimen to reduce the potentially harmful effects on various organ systems.

Síndrome de Reacción a drogas con Eosinofilia y Síntomas Sistémicos (DRESS) asociados a Nefritis Túbulo Intersticial Aguda en un adolescente

“…La incidencia en población pediátrica no está bien establecida, pero se estima que la entidad se presenta entre 1:1000 a 1:10000 exposiciones a medicamentos, siendo los anticonvulsivantes (50%) y antibióticos (30,8%) las causas más comunes, con reportes de tasas de mortalidad hasta del 10% (3,5,9,11).…”

“…Este puntaje fue publicado originalmente por Kardaun et al, con una puntuación inicial (criterios de inclusión), seguida de la confirmación (criterios de validación). (3,(11)(12)(13)(14).…”

<p><strong>Faktor risiko dan tatalaksana kandidiasis oral pada pasien dengan <em>drug reaction with eosinophilia and systemic symptoms</em> (DRESS)</strong></p><p><strong><em>Risk factors and management of oral candidiasis in drug reaction with eosinophilia and systemic symptoms (DRESS) patients</em></strong></p>

“…4,6 DRESS juga diyakini sebagai hasil dari interaksi antara berbagai faktor, termasuk genetika, kelainan metabolisme, dan reaktivasi virus golongan herpes tertentu, termasuk Epstein-barr virus (EBV) dan Human herpes virus 6 (HHV-6). 7 Gambaran klinis dari DRESS meliputi demam, ruam, dan limfadenopati. Gejala dimulai sekitar 3 sampai 8 minggu setelah terpapar agen penyebab.…”

“…Gejala dimulai sekitar 3 sampai 8 minggu setelah terpapar agen penyebab. 4,5,7 Penatalaksanaan Sindrom DRESS yang utama adalah menentukan identifikasi dan menghentikan obat yang diduga menjadi penyebab. Tatalaksana untuk DRESS yang direkomendasikan berupa pemberian kortikosteroid sistemik, namun pemberian kortikosteroid ini dapat menimbulkan manifestasi oral yaitu kandidiasis oral.…”

“…Tatalaksana untuk DRESS yang direkomendasikan berupa pemberian kortikosteroid sistemik, namun pemberian kortikosteroid ini dapat menimbulkan manifestasi oral yaitu kandidiasis oral. 7,8,9,10 Kandidiasis oral merupakan infeksi oportunistik pada rongga mulut yang disebabkan oleh pertumbuhan berlebihan Candida spp. Faktor predisposisi dan faktor risiko terjadinya kandidiasis oral adalah menurunnya sistem imun seperti pada penderita HIV dan diabetes mellitus, penggunaan gigi tiruan yang tidak dibersihkan, efek dari radioterapi, penggunaan obat-obatan seperti kortikosteroid, obat antiepilesi, alopurinol, sulfonamid, dan antibiotik spektrum luas jangka panjang serta kebersihan rongga mulut yang buruk.…”