Idiosyncratic Drug-Induced Liver Injury Associated With and Without Drug Reaction With Eosinophilia and Systemic Symptoms

Abstract

Immunoallergic drug-induced liver injury (DILI) presenting with features of drug reaction with eosinophilia and systemic symptoms (DRESS) is a distinct phenotype. We describe the clinical characteristics, hepatitis pattern, severity, complications, and implicated medications in DILI patients with and without DRESS. METHODS:Using established criteria, we analyzed DILI registry patients with and without DRESS from 1998 to 2021. RESULTS:DILI associated with DRESS (DwD) comprised 179 among 943 cases (19%) of DILI. Compared with the cohort without DRESS, patients with DwD are more often women and have shorter latency, lesser degrees of injury (P < 0.01), and lower mortality (7.8%) than those without DRESS (16%). Antiepileptic drugs (36%), sulfonamides (19%), antituberculosis drugs (14%), antibiotics (10%), and antiretroviral drugs (8%) account for 87% of the cases of DwD.

Characterization of drug-induced liver injury associated with drug reaction with eosinophilia and systemic symptoms in two prospective DILI registries

“…In the present study cholestatic-mixed injury was reported as the most common liver injury pattern in patients with DILI-DRESS. This finding is consistent with other studies that reported a significantly higher frequency of cholestatic injury in DILI-DRESS cases (Lin et al 2015 ; Huang et al 2021 ; Devarbhavi et al 2022 ).…”

“…A summary of the clinical characteristics and outcomes of DILI-DRESS patients in prospective and retrospective studies published from Asian countries is shown in Table 4 . The prevalence of DILI-DRESS in this study (3.7%) is similar to other long-term population-based studies (5.3%) (Huang et al 2021 ), but significantly lower compared to a recent single-centre Indian study (19%) (Devarbhavi et al 2022 ). Geographic, ethnic, and demographic differences and divergences in drug prescription patterns could explain these discrepancies in DILI-DRESS incidence.…”

“…Geographic, ethnic, and demographic differences and divergences in drug prescription patterns could explain these discrepancies in DILI-DRESS incidence. For instance, sulphonamides, mainly dapsone, rarely used in Western countries, was the 2nd drug class involved in DILI-DRESS in one of these studies (Devarbhavi et al 2022 ). Furthermore, the increased mortality rates observed in these studies could be due to several factors, such a higher prevalence of pre-existing hepatic diseases, comorbidities, or a more frequent involvement of extrahepatic organs, which might have determined the poorer outcome (Chalasani et al 2015 ; Ghabril et al 2019 ).…”

“…Liver injury is usually defined as a mild elevation of transaminases (> 2 times the upper limit of normal [ULN]) (Kardaun et al 2013 ), which is less stringent criteria than the thresholds proposed by an international DILI working group to exclude transaminase elevations of uncertain significance and an adaptative phenomena (Aithal et al 2011 ). DILI associated with DRESS has gained interest in recent years, and several studies of Asian patients with this particular phenotype of DILI have been published recently (Huang et al 2021 ; Devarbhavi et al 2022 ).…”

Drug reaction with eosinophilia and systemic symptoms syndrome secondary to Chinese oral herbal paste: a case report

“…DRESS syndrome is a severe, multi-organic and potentially life-threatening drug-induced hypersensitivity reaction that typically develops within 2–6 weeks of exposure to several common drugs such as clozapine, yet is less recognizable in daily practice considering the protean clinical manifestations [ 4 , 5 ]. To date, few cases of DRESS syndrome caused by HDS, especially oral Chinese herbal paste, have ever been reported [ 4 ].…”