Drug rash with eosinophilia and systemic symptoms secondary to sulfasalazine

Abstract

A severe cutaneous eruption in an unwell patient can be a major cause of physician anxiety. With numerous differential diagnoses, an early accurate diagnosis can be challenging. infectious causes are the most important to exclude in a timely manner and drug rash and eosinophilia with systemic symptoms (DRESS) is another differential diagnosis that should be considered in children. This hypersensitivity reaction is associated with multisystem involvement. Children with underlying chronic diseases may have impairment of normal metabolic pathways and are also often on multiple medications. Therefore, drugs should always be considered in the aetiopathology of any new symptoms and signs. This case report informs readers of the association of sulfasalazine and DRESS in an 11-year-old with inflammatory bowel disease and discusses its pathogenesis and treatment. Increased awareness of this disorder will hopefully lead to increased reporting and consequently illuminate the syndrome more clearly and help guide its prevention and treatment.

Thyroid dysfunction in drug reaction with eosinophilia and systemic symptoms (DRESS): an unusual manifestation of systemic drug hypersensitivity

“…As this case illustrates, there is typically a delay in the presentation of DRESS, with a latency period of 4–8 weeks after the causative drug has been commenced. DRESS caused by sulfonamides such as sulfasalazine is well documented 4–6 . Although thyroid involvement has been reported with other causative agents in DRESS, we believe this to be the first case report of a delayed thyroiditis in a sulfasalazine‐induced DRESS.…”

Successful Treatment of Sulfasalazine‐Induced DRESS Syndrome with Corticosteroids and N‐Acetylcysteine

“…4 There are multiple cases of sulfasalazine-induced DRESS reported in the literature (see table 2). [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] As seen in our case, the presentation of fever and rash weeks after initiation of sulfasalazine is characteristic of DRESS. Leukocytosis, eosinophilia, and lymphadenopathy are often cited although the degree of leukocytosis in our case is significant.…”

Sulfasalazin İle Tetiklenen İlaçla İlişkili Hipersensitivite Sendromu

“…Sulfasalazine bağlı İİHS ve DRESS, geç dönemde akut interstisyel nefrit ve karaciğer transplantasyonu ile sonuçlanan karaciğer yetmezliğine neden olabilir. Hatta karaciğer transplantasyonu sonrası karaciğer yetmezliği tablosu tekrarlayan bir olgu bildirilmiştir [10][11][12] . İlaç reaksiyonlarında klinik görünüm patogenezde daha baskın olan mekanizmayı yansıtmaktadır.…”