Detection of SARS‐CoV‐2 in a case of DRESS by sulfasalazine: could there be a relationship with clinical importance?

Balconi, Sindy Natália; Lopes, Natane Tenedini; Luzzatto, Laura; Bonamigo, Renan Rangel

doi:10.1111/ijd.15316

Cited by 9 publications

(5 citation statements)

References 5 publications

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“…Since the beginning of the Coronavirus disease 19 (COVID‐19) pandemic, 6 different types of DDH have been reported in severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐infected patients, 7 raising the question as to how COVID‐19 is associated with their development. We and others have reported glucocorticoid‐refractory severe DRESS with massive eosinophilia in COVID‐19 patients 8,9 . Besides DDH, other cutaneous eruptions have been associated with SARS‐CoV‐2 infection and have been observed in approximately 1–20% of the patients 10–15 …”

Section: Introductionmentioning

confidence: 90%

“…We and others have reported glucocorticoid‐refractory severe DRESS with massive eosinophilia in COVID‐19 patients. 8 , 9 Besides DDH, other cutaneous eruptions have been associated with SARS‐CoV‐2 infection and have been observed in approximately 1–20% of the patients. 10 , 11 , 12 , 13 , 14 , 15 These various skin manifestations of SARS‐CoV‐2 infection 16 , 17 may be due in part to the SARS‐CoV‐2 spike protein receptor (angiotensin‐converting enzyme 2, ACE2) being expressed by keratinocytes.…”

Section: Introductionmentioning

confidence: 99%

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Cutaneous and systemic hyperinflammation drives maculopapular drug exanthema in severely ill COVID‐19 patients

Mitamura¹,

Schulz

Oro

et al. 2021

Allergy

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Background Coronavirus disease‐2019 (COVID‐19) has been associated with cutaneous findings, some being the result of drug hypersensitivity reactions such as maculopapular drug rashes (MDR). The aim of this study was to investigate whether COVID‐19 may impact the development of the MDR. Methods Blood and skin samples from COVID‐19 patients (based on a positive nasopharyngeal PCR) suffering from MDR (COVID‐MDR), healthy controls, non‐COVID‐19—related patients with drug rash with eosinophilia and systemic symptoms (DRESS), and MDR were analyzed. We utilized imaging mass cytometry (IMC) to characterize the cellular infiltrate in skin biopsies. Furthermore, RNA sequencing transcriptome of skin biopsy samples and high‐throughput multiplexed proteomic profiling of serum were performed. Results IMC revealed by clustering analyses a more prominent, phenotypically shifted cytotoxic CD8 + T cell population and highly activated monocyte/macrophage (Mo/Mac) clusters in COVID‐MDR. The RNA sequencing transcriptome demonstrated a more robust cytotoxic response in COVID‐MDR skin. However, severe acute respiratory syndrome coronavirus 2 was not detected in skin biopsies at the time point of MDR diagnosis. Serum proteomic profiling of COVID‐MDR patients revealed upregulation of various inflammatory mediators (IL‐4, IL‐5, IL‐6, TNF, and IFN‐γ), eosinophil and Mo/Mac ‐attracting chemokines (MCP‐2, MCP‐3, MCP‐4 and CCL11). Proteomics analyses demonstrated a massive systemic cytokine storm in COVID‐MDR compared with the relatively milder cytokine storm observed in DRESS, while MDR did not exhibit such features. Conclusion A systemic cytokine storm may promote activation of Mo/Mac and cytotoxic CD8 + T cells in severe COVID‐19 patients, which in turn may impact the development of MDR.

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Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Cutaneous and systemic hyperinflammation drives maculopapular drug exanthema in severely ill COVID‐19 patients

Mitamura¹,

Schulz

Oro

et al. 2021

Allergy

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“…These patients are particularly prone to classical risk factors for DIHS/DRESS, as they are frequently affected by multiple comorbidities and exposed to several drugs potentially associated with this syndrome. Few isolated cases of DIHS/DRESS in patients with COVID-19 have been described in the literature [ 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ], but the actual incidence of this condition in patients with SARS-CoV-2 pneumonia is still to be fully explored. In a retrospective cohort analysing 9330 patients hospitalised with COVID-19 from a US healthcare system [ 99 ] between January 2020 and May 2021, six cases of DRESS syndrome were identified, corresponding to an incidence of 6.43 per 10,000 patients.…”

Section: Aetiology and Pathogenesismentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses

et al. 2023

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a heterogeneous, multiorgan and potentially life-threatening drug-hypersensitivity reaction (DHR) that occurs several days or weeks after drug initiation or discontinuation. DHRs constitute an emerging issue for public health, due to population aging, growing multi-organ morbidity, and subsequent enhanced drug prescriptions. DRESS has more consistently been associated with anticonvulsants, allopurinol and antibiotics, such as sulphonamides and vancomycin, although new drugs are increasingly reported as culprit agents. Reactivation of latent infectious agents such as viruses (especially Herpesviridae) plays a key role in prompting and sustaining aberrant T-cell and eosinophil responses to drugs and pathogens, ultimately causing organ damage. However, the boundaries of the impact of viral agents in the pathophysiology of DRESS are still ill-defined. Along with growing awareness of the multifaceted aspects of immune perturbation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the ongoing SARS-CoV-2-related disease (COVID-19) pandemic, novel interest has been sparked towards DRESS and the potential interactions among antiviral and anti-drug inflammatory responses. In this review, we summarised the most recent evidence on pathophysiological mechanisms, diagnostic approaches, and clinical management of DRESS with the aim of increasing awareness on this syndrome and possibly suggesting clues for future research in this field.

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“…This synergy between drug and cytokine storm triggered by COVID-19, mainly TNF α, IFN-gamma, LT CD 8+, and Th17 deregulation, can induce a hypersensitivity reaction to the drugs involving toxidermia. However, a SARS-CoV-2 infection must be suspected and looked for in front of any toxidermia with incompatible occurrence mode (delay) and/or severe evolution, as in the case of our patient hospitalized at our department for the management of a DRESS syndrome, which turned thereafter to a Stevens-Johnson syndrome in spite of the stop of all medication [22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and Autoimmunity in Dermatology: A Moroccan Case Series and Literature Review

Benhayoun,

Hali,

El Fatoiki

et al. 2024

Cureus

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Introduction: Since the beginning of the pandemic, many skin manifestations associated with COVID-19 have been reported. New reports show that COVID-19 can lead to autoimmune diseases (AIDs) and autoinflammatory diseases, especially dermatological. Methods: A prospective study was conducted by the dermatology department of the Centre Hospitalier Universitaire Ibn Rochd (CHU Ibn Rochd) of Casablanca in Morocco since the beginning of the pandemic including 18 patients with COVID-19-related skin manifestations. Results: Eighteen cases were collected with confirmed SARS-CoV-2 infection. The mean COVID score was 0.7. A percentage (94.44%) of the cases had general symptoms. Skin involvement was variable, mainly maculopapular rash (44.44%), purpura (27.77%), urticaria, varicelliform rash, necrotic lesions of the face, and pityriasis rosea Gibert (PRG)-like lesions. Mucosal involvement was found in 50%. Viral reactivation was found in 5.55%. Telogen effluvium was found in 22.22%. Moreover, AID was triggered by COVID-19: lupus (11.11%), associated with antiphospholipid syndrome (APL Sd) (5.55%), psoriasis (11.11%), alopecia, and pemphigus. Severe toxidermia was potentiated by SARS-CoV-2 infection (22.22%): Stevens-Johnson syndrome (Sd), acute generalized exanthematous pustulosis (APEG), and drug reaction with eosinophilia and systemic symptoms (DRESS). Conclusion: The interest of this work is to report our experience during the COVID-19 pandemic to understand some pathophysiological mechanisms of its dermatological manifestations and to draw the attention of clinicians to the link of this infection with autoimmune and autoinflammatory diseases and toxidermia.

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Detection of SARS‐CoV‐2 in a case of DRESS by sulfasalazine: could there be a relationship with clinical importance?

Cited by 9 publications

References 5 publications

Cutaneous and systemic hyperinflammation drives maculopapular drug exanthema in severely ill COVID‐19 patients

Cutaneous and systemic hyperinflammation drives maculopapular drug exanthema in severely ill COVID‐19 patients

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses

COVID-19 and Autoimmunity in Dermatology: A Moroccan Case Series and Literature Review

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