High-dose Intravenous Immunoglobulin Monotherapy for Drug-induced Hypersensitivity Syndrome

Kito, Yukiko; Ito, Taisuke; Tokura, Y.; Hashizume, Hideo

doi:10.2340/00015555-1168

Cited by 45 publications

(28 citation statements)

References 11 publications

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“…Nevertheless, the most widely accepted and used treatment is systemic corticosteroids . There are case reports of successful treatment with plasma exchange, intravenous immunoglobulins, cyclosporine, and N‐acetylcysteine . All our patients were treated with either oral or intravenous corticosteroids, with two treated with intravenous pulsed methylprednisolone.…”

Section: Discussionmentioning

confidence: 99%

Drug reaction with eosinophilia and systemic symptoms in a cohort of Asian children

Han

Koh

Wong

2019

Pediatric Dermatology

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Background/objectives: Drug reaction with eosinophilia and systemic symptoms (DRESS) is rare but potentially fatal in children. Fever and rash, which are salient features of DRESS, may mimic other commonly encountered pediatric conditions. We profiled the DRESS cases in a tertiary children's hospital in Singapore. Methods:The medical records of all pediatric DRESS patients diagnosed from 2006 to 2016. Data on epidemiology, inciting drugs, clinical, pathologic manifestations, and treatment were assessed.Results: Ten patients aged 4-16 years old were diagnosed with DRESS within the 10year period. Drugs implicated were antibiotics, such as trimethoprim-sulfamethoxazole, and anticonvulsants, such as carbamazepine, phenobarbitone, and levetiracetam. All patients had fever and pruritic exanthems. Desquamation, purpura, and oral mucositis were also observed. Lymphadenopathy, hepatomegaly, and facial edema occurred frequently. There was liver involvement in all cases, but none progressed to liver failure.Seven patients had eosinophilia, and nine had atypical lymphocytosis. Other laboratory abnormalities included low hemoglobin, thrombocytosis, and prolonged coagulation times. All patients received systemic corticosteroids of varying durations and dosages.

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Section: Discussionmentioning

confidence: 99%

Drug reaction with eosinophilia and systemic symptoms in a cohort of Asian children

Han

Koh

Wong

2019

Pediatric Dermatology

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“…Early recognition and withdrawal of the causative drug along with the provision of supportive treatment are essential in the management of DRESS; however, these measures are not always sufficient to prevent the progression of this condition . Systemic corticosteroids, immunosuppressants such as cyclophosphamide and cyclosporin, IV immunoglobulin, and N‐acetylcysteine have all been reported to be beneficial. However, systemic corticosteroids are usually the first choice .…”

Section: Discussionmentioning

confidence: 99%

Drug reaction with eosinophilia and systemic symptoms: manifestations, treatment, and outcome in 17 patients

2014

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“…A síndrome de DRESS apresenta características particularmente distintas das outras reações cutâneas a fármacos que importa salientar, nomeadamente o tempo de latência longo (cerca de duas a oito semanas entre o início da terapêutica com o fármaco e o aparecimento dos primeiros sintomas), tal como no caso clínico apresentado, o agravamento clínico e a evolução prolongada de doença com recaídas frequentes após a descontinuação de reativação viral, predominando o fenótipo citotóxico CD8 + , com diminuição dos linfócitos T CD4 + , aumento do fator de necrose tumoral α e interferão-γ. 9,11,12 Mais recentemente, outros vírus da família herpes, como o vírus Epstein Barr, citomegalovirus e o HVH-7, mostraram reativação durante a síndrome de DRESS de uma forma sequencial. 9 Esta característica poderia explicar as recorrências da síndrome de DRESS apesar do fármaco potencialmente responsável já ter sido descontinuado.…”

Section: Discussionunclassified

Síndrome Induzida por Fármacos com Eosinofilia e Sintomas Sistémicos (DRESS) Associada aos Antituberculosos: O Papel da Imunoglobulina Endovenosa

Rangel

Moreira

Duarte³

et al. 2017

Acta Pediátrica Port

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A síndrome induzida por fármacos com eosinofilia e sintomas sistémicos é uma forma rara de hipersensibilidade a fármacos com desfecho potencialmente fatal. Descreve-se o caso clínico de uma adolescente sob tratamento para tuberculose ativa, que iniciou quadro de vómitos, diarreia, astenia e exantema maculopapular pruriginoso à sexta semana de tratamento. Ao sexto dia de doença, iniciou febre elevada e agravamento do exantema. Apresentava linfócitos atípicos circulantes e hepatite, sendo suspenso o tratamento com antituberculosos. A investigação etiológica autoimune, infeciosa viral e bacteriana foi negativa. Ao décimo sétimo dia de doença, pela persistência da febre, eritema morbiliforme com áreas vasculíticas, compromisso da função hepática, derrame pleural bilateral e eosinofilia (1690 células/μL) foi diagnosticada síndrome induzida por fármacos com eosinofilia e sintomas sistémicos e instituído tratamento com imunoglobulina endovenosa, com melhoria clínico-analítica progressiva. Esta síndrome é uma complicação rara do tratamento com antituberculosos, sendo a imunoglobulina endovenosa uma terapêutica eficaz em alternativa aos corticosteroides. Palavras-chave:Adolescente; Antituberculosos/efeitos adversos; Eosinofilia/induzida quimicamente; Imunoglobulinas Intravenosas/uso terapêutico; Síndrome de Hipersensibilidade a Medicamentos/etiologia Abstract Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare drug hypersensitivity reaction that can have a fatal outcome. The authors report the case of a teenager under treatment for suspected active tuberculosis for six weeks, who developed nausea, vomiting, diarrhoea, asthenia and maculopapular rash. On day six of disease, with fever and worsening of the rash, she presented atypical circulating lymphocytes and hepatitis, prompting suspension of antituberculosis therapy. Investigation of autoimmune, viral and bacterial infectious aetiologies was negative. On day 17 of the disease, due to persistent fever, generalised morbilliform rash with vasculitic areas, hepatic dysfunction, pleural effusion and eosinophilia (1690 cells/μl), she was diagnosed with DRESS syndrome. Treatment with intravenous immunoglobulin was started, resulting in clinical and laboratory improvement. This syndrome is a rare complication of antituberculosis treatment, and intravenous immunoglobulin is an effective alternative treatment option to corticosteroids.

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High-dose Intravenous Immunoglobulin Monotherapy for Drug-induced Hypersensitivity Syndrome

Cited by 45 publications

References 11 publications

Drug reaction with eosinophilia and systemic symptoms in a cohort of Asian children

Drug reaction with eosinophilia and systemic symptoms in a cohort of Asian children

Drug reaction with eosinophilia and systemic symptoms: manifestations, treatment, and outcome in 17 patients

Síndrome Induzida por Fármacos com Eosinofilia e Sintomas Sistémicos (DRESS) Associada aos Antituberculosos: O Papel da Imunoglobulina Endovenosa

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