Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Series of 49 French Pediatric Cases

Diagnosing drug reaction with eosinophilia and systemic symptoms in a medically complex young child

“…In most cases of DRESS, the reaction begins 2–8 weeks after initiation of the causative drug however, these reports are based on adults and data in early childhood are not present. In our patient's case, her rash began 7 days after commencement of the suspected culprit drug, phenobarbitone which is consistent with early‐onset DRESS syndrome 4 …”

“…Identification and withdrawal of the causative drug with supportive treatment is the mainstay of treatment for patients with DRESS. Treatment with topical and/or systemic corticosteroids depending on DRESS severity can also hasten resolution of the rash and other symptoms 4 …”

“…In our patient's case, her rash began 7 days after commencement of the suspected culprit drug, phenobarbitone which is consistent with early-onset DRESS syndrome. 4 Drugs most implicated are antiepileptics (50%), including phenobarbitone (11.5%). The second most common causative drugs are antibiotics (30.8%)most commonly vancomycin and trimethoprim-sulfamethoxazole.…”

“…Treatment with topical and/or systemic corticosteroids depending on DRESS severity can also hasten resolution of the rash and other symptoms. 4 Accurate diagnosis of DRESS and careful consideration of differential diagnoses is important to ensure timely disease management and avoid inappropriate mislabelling of medication sensitivity which would limit future therapeutic options.…”

Therapeutic Management of Idiosyncratic Drug-Induced Liver Injury and Acetaminophen Hepatotoxicity in the Paediatric Population: A Systematic Review

“…In a recent systematic review including 144 case reports and case series with 354 reported paediatric DRESS cases, nearly 60% of children were treated with systemic corticosteroids, while 13% received intravenous immunoglobulins (IVIg) [66]. In addition, in a case series of 49 well defined DRESS cases (84% with liver injury), corticosteroids (topical for mild cases, and systemic for more severe cases) were the main therapeutic option, whereas IVIg and cyclosporin were used only in a limited number of cases [67]. Overall, these findings are in line with the hypothesis that corticosteroids are the mainstay of treatment for DRESS, despite the lack of high-quality evidence to support its benefit.…”