Drug Rash with Eosinophilia and Systemic Symptoms versus Stevens-Johnson Syndrome – a Case that Indicates a Stumbling Block in the Current Classification

Wolf, Ronni; Davidovici, Batya B.; Matz, Hagit; Mahlab, Keren; Orion, Edith; Sthoeger, Zev

doi:10.1159/000095437

Cited by 24 publications

(12 citation statements)

References 27 publications

(12 reference statements)

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“…Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by cutaneous drug eruption, eosinophilia, and systemic symptoms (lymphadenopathy, hepatitis, interstitial nephritis, interstitial pneumonitis, and/or carditis) 1. This paper describes a patient with DRESS syndrome caused by allopurinol, the clinical presentation of which mimicked community-acquired pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Allopurinol causing drug rash with eosinophilia and systemic symptoms syndrome: a challenging diagnosis

Hassan

Wetz²,

Zouein³

2011

IJGM

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BackgroundDrug rash with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by cutaneous drug eruption, eosinophilia, and systemic symptoms. The syndrome is difficult to diagnose due to its clinical heterogeneity and long latency period (2–6 weeks).Case reportThis paper describes a 73-year-old man who presented with a rash that started 1 week prior to his presentation. The rash was associated with fever, dyspnea, and cough. He was admitted for pneumonia and started on intravenous antibiotics. After 3 days, he became confused and developed multiorgan dysfunction. Work-up for possible hematologic disorders, autoimmune diseases, and pneumonia was negative. One month prior to the onset of the rash, allopurinol had been prescribed for asymptomatic hyperuricemia. The allopurinol was stopped and corticosteroids were started; 2 days later, the patient became afebrile and the dyspnea resolved. He was diagnosed with DRESS syndrome, which is associated with high mortality.ConclusionThe recent introduction of a drug followed by a rash, multiorgan dysfunction, and eosinophilia should raise the suspicion of DRESS syndrome. Early cessation of the introduced drug is key to survival. Clinicians should be aware of this potential adverse reaction when prescribing any new drug, including allopurinol.

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Section: Introductionmentioning

confidence: 99%

Allopurinol causing drug rash with eosinophilia and systemic symptoms syndrome: a challenging diagnosis

Hassan

Wetz²,

Zouein³

2011

IJGM

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“…The drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, previously referred to as the 'drug hypersensitivity syndrome', is an adverse drug reaction characterized by skin rash, fever, lymph-node enlargement and internal organ involvement 1. The definition of DRESS is flawed in that it does not characterize the nature of the cutaneous rash.…”

Section: Introductionmentioning

confidence: 99%

“…DRESS and SJS are similar in that the clinical manifestations typically occur within 2 to 6 weeks after initiating drug therapy 1. However, the two syndromes have different characteristics, treatments and prognoses.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Causes and Clinical Features of Drug Rash With Eosinophilia and Systemic Symptoms and Stevens-Johnson Syndrome

Jeung

Lee

et al. 2010

Allergy Asthma Immunol Res

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PurposeDrug rash with eosinophilia and systemic symptoms (DRESS) and the Stevens-Johnson syndrome (SJS) are both severe drug reactions. Their pathogenesis and clinical features differ. This study compared the causes and clinical features of SJS and DRESS.MethodsWe enrolled 31 patients who were diagnosed with DRESS (number=11) and SJS (number=20). We retrospectively compared the clinical and laboratory data of patients with the two disorders.ResultsIn both syndromes, the most common prodromal symptoms were itching, fever, and malaise. The liver was commonly involved in DRESS. The mucosal membrane of the oral cavity and eyes was often affected in SJS. The most common causative agents in both diseases were antibiotics (DRESS 4/11 (37%), SJS 8/20 (40%)), followed by anticonvulsants (DRESS 3/11 (27%), SJS 7/20 (35%)). In addition, dapsone, allopurinol, clopidogrel, sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs) were sporadic causes.ConclusionsThe most common causes of DRESS and SJS were antibiotics, followed by anticonvulsants, NSAIDs and sulfonamides. The increase in the use of antibiotics in Korea might explain this finding.

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“…LTG is considered to be toxic at y15 mg/l (Devulder, 2006). In studies of epilepsy and neuropathic pain, a daily oral dose has ranged from 300 to 400 mg, although doses up to 800 mg were administered resulting in a plasma level below 15 mg/l (Wolf et al, 2006). Surprisingly, LTG-associated dermatological events (DEs) that can be life-threatening do not correlate with plasma drug levels.…”

Section: Pharmacokinetics and Drug Interactionsmentioning

confidence: 99%

“…For instance, bullous fixed drug eruptions are extremely benign. On the other hand, the mortality rate is 5 % for acute generalized exanthematous pustulosis, 10 % for SJS, and up to 45 % for TEN (Roujeau, 2005;Wolf et al, 2006). Typically, the rash associated with LTG occurs between day 5 and week 8 of administration (Calabrese et al, 2002).…”

Section: Characteristics Of Benign Vs Serious Rashmentioning

confidence: 99%

Lamotrigine-associated rash: to rechallenge or not to rechallenge?

Lorberg

Youssef

Bhagwagar

2008

Int. J. Neuropsychopharm.

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The major burden of illness in bipolar disorder (BD) is in the depressive pole. Lamotrigine has been shown to be useful in the long-term prophylaxis of depressive episodes in BD. Current guidelines recommend discontinuing lamotrigine in patients who develop rash. Our objective in this paper is to review literature to identify possible predictors of serious vs. benign rash that might help guide clinical decision-making and recommend titration strategy for re-introduction of lamotrigine, if indicated. We performed a search of the literature between 1966 and July 2008 to investigate the phenomenon of lamotrigine-induced rash and rechallenge procedures. The search identified six reports, and we were able to identify another case series from reviewing the bibliography of all of the above papers. We reviewed all the papers of lamotrigine rash rechallenge that resulted from the literature search. These papers describe 44 cases of lamotrigine rechallenge. Currently, there are 39 reported cases in the literature of successful lamotrigine rechallenge after a rash and five cases with rash recurrence. There are some characteristics of the rash that can help identify serious cases from benign ones. In addition, very slow titration of lamotrigine is crucial to the reduction of rash recurrence rate. Several cases that develop benign rash on lamotrigine can be rechallenged without adverse consequences. We believe that lamotrigine rechallenge in bipolar depression is an under-utilized option in our clinical armamentarium, and further studies are needed to guide us in this area.

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Drug Rash with Eosinophilia and Systemic Symptoms versus Stevens-Johnson Syndrome – a Case that Indicates a Stumbling Block in the Current Classification

Cited by 24 publications

References 27 publications

Allopurinol causing drug rash with eosinophilia and systemic symptoms syndrome: a challenging diagnosis

Allopurinol causing drug rash with eosinophilia and systemic symptoms syndrome: a challenging diagnosis

Comparison of the Causes and Clinical Features of Drug Rash With Eosinophilia and Systemic Symptoms and Stevens-Johnson Syndrome

Lamotrigine-associated rash: to rechallenge or not to rechallenge?

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