Isoniazid-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Presenting as Acute Eosinophilic Myocarditis

Zhang, Sainan; He, Qiu-Xiang; Yang, Naibin; Ni, Shun-Lan; Lu, Mingqin

doi:10.2169/internalmedicine.54.3511

Cited by 17 publications

(9 citation statements)

References 13 publications

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“…In conclusion, anti-TBC drugs can rarely cause cardiotoxicity and heart failure; there are a few reports published. None of those adverse events occurred in our case during follow-up [7,8].…”

mentioning

confidence: 52%

Acute pericarditis in a young patient with IgG immunodeficiency

Skowerski¹,

Skowerski²,

Grzywocz³

et al. 2020

aoms

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A 35-year-old female health care worker with IgG deficiency was urgently admitted to our department due to pericardial effusion, which was diagnosed during a follow-up visit in an outpatient clinic. The IgG deficiency was detected over 10 years ago and classified by a hematologist as mild. There was no known history of IgG replacement therapy or chronic or recurrent infections. Two months prior to admission, she had been urgently hospitalized in a cardio-thoracic center due to an episode of cardiac tamponade evacuated with a pericardiocentesis. She had been discharged after 5 days in good condition and remained asymptomatic until a week before admission to our hospital. The pericardial fluid had been sent to diagnostics, but the test results remained unknown. The patient presented fatigue, dyspnea, and heart failure symptoms (New York Heart Association (NYHA) class III). Physical examination revealed tachycardia (heart rate 120 bpm) and hypotension (90/60 mm Hg). The patient denied weight loss, cough, fever, or night chills. Laboratory tests showed anemia (hemoglobin 8.9 mg/dl), elevated C-reactive protein level (CRP 64 mg/dl), no leukocytosis, and elevated CA-125 level (169.3 U/ml, reference < 35 U/ml). In the ECG, sinus rhythm with tachycardia (120 bpm), PR depression in inferior leads (II, III, aVF), and negative T waves in precordial leads (V2-V6) were found. Transthoracic echocardiography (TTE) revealed preserved left ventricular ejection fraction (LVEF, > 60%), pericardial effusion (> 30 mm of fluid), and impaired right ventricular function (right atrium and ventricle were collapsing; Figures 1 A, B). A diagnosis of cardiac tamponade was made, and urgent pericardiocentesis was performed. Over 450 ml of bright yellow, cloudy fluid was evacuated (Figure 1 C). The patient's condition improved significantly. In the angio-CT, hepatomegaly, a tumor in the uterus (defined by the radiologist as a uterine fibroid), and bilateral pleural effusion were described. Rheumatic diseases and HIV infection were excluded. The pericardial fluid's microscopic test revealed Mycobacterium tuberculosis, whereas the pleural fluid's microscopic test for Mycobacterium tuberculosis was negative. Initial anti-tuberculosis treatment was administered, and the patient was transferred to the pulmonology ward for further treatment. The tuberculosis was treated with rifampicin (6 months), pyrazinamide (3 months), ethambutol (3 months), and prednisolone (30 mg daily for 8 weeks) due to pericarditis. Two months after the initiation of TBC treatment, she was urgently admitted to the hospital due to jaundice, which was caused by TBC therapy. The pyrazinamide and rifam

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mentioning

confidence: 52%

Acute pericarditis in a young patient with IgG immunodeficiency

Skowerski¹,

Skowerski²,

Grzywocz³

et al. 2020

aoms

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“…Имеется ряд сообщений о развитии эозинофи лии на фоне терапии противотуберкулезными ЛС [43][44][45][46]: этамбутолом (эозинофильный легочный инфильтрат, эозинофилия, кожная сыпь [43]), ри фампицином (эозинофилия в сочетании с легоч ными и/или кишечными симптомами [44,45]).…”

Section: антибактериальные и противогрибковые средстваunclassified

Drug-Induced Eosinophilia

Остроумова

Шахова

Кочетков

2019

Bezopasnost' i risk farmakoterapii

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Резюме. Эозинофилия может быть вызвана разными причинами, в том числе приемом лекарственных средств. Актуальность изучения проблемы лекарственно-индуцированной эозинофилии обусловлена тяжелыми последствиями, ассоциированными с данным состоянием, в частности эозинофилией-миалгией, DRESS-синдромом, поражением сердца и мультисистемными проявлениями, которые могут привести к летальному исходу. Цель работы: анализ и систематизация данных о факторах риска развития лекарственно-индуцированной эозинофилии и ее распространенности при применении различных групп лекарственных средств, а также обобщение информации о существующих способах профилактики и коррекции данного состояния. Установлено, что наиболее часто лекарственно-индуцированная эозинофилия развивается на фоне приема антибиотиков групп пенициллинов, цефалоспоринов, тетрациклинов, а также сульфаниламидов, противомалярийных, противолепрозных, противосудорожных и нестероидных противовоспалительных препаратов. Систематизированы данные о распространенности лекарственно-индуцированной эозинофилии при использовании лекарственных средств различных групп с указанием типа реакции и тяжести состояния. Данное патологическое состояние встречается у пациентов всех возрастных категорий, с одинаковой частотой как у мужчин, так и у женщин. К факторам риска возникновения лекарственно-индуцированной эозинофилии относят наличие ряда клональных заболеваний крови, некоторых других заболеваний (аллергических и атопических), инфекций (особенно паразитарных), опухолей, а также одновременный прием двух или более лекарственных средств из указанных выше групп. Бессимптомная эозинофилия не требует прекращения проводимой медикаментозной терапии. При наличии клинической симптоматики, связанной с эозинофилией, препарат целесообразно отменить или заменить, а при невозможности этого лечение продолжают на фоне обязательного мониторинга клинической картины и гематологических показателей. Для обеспечения адекватной профилактики и ранней диагностики лекарственно-индуцированной эозинофилии необходимо повышать информированность практикующих врачей разных специальностей о возможности развития такой нежелательной реакции на фоне фармакотерапии. Ключевые слова: эозинофилия; лекарственно-индуцированная эозинофилия; нежелательные побочные реакции; антибиотики; сульфаниламиды; противомалярийные препараты; противосудорожные препараты; нестероидные противовоспалительные препараты

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“…Sülfasalazin, nonsteroid antiinflamatuar, antiviral ilaçlar (telaprevir) ve tüberküloz tedavisinde kullanılan ilaç-lar bunlar arasındadır. [1][2][3][4][5][6][7][8][9][10][11] Yang ve ark., antikonvülzan ilaçlardan karbamazebin ve fenitoinin tüm DRESS sendromu vakalarının %43,6'sından sorumlu olduğunu bildirmişlerdir. 7 Farklı genetik ve etnik predispozisyon nedeni ile dünyanın farklı coğrafi bölgelerinde farklı ilaçlar ön plana çıkabil-mektedir.…”

Section: 7unclassified

“…Daha az sıklıkla gözlenen ama önemli olan organ tutulumları arasında ensefalit, interstisyel pnömoni, vaskülit, miyozit, pankreatit, subakut tiroidit, miyokardit sayılabilir. 1,2,10 Özellikle tiroidit bulguları DRESS sendromunun bulguları ile benzeştiğinden atlanabilmektedir. 13 Bu nedenle DRESS sendromlu hastalarda tiroid fonksiyon testlerinin uzun süreli izlemi önerilmektedir.…”

Section: 7unclassified

DRESS Syndrome Induced by Sulfasalazine with Amoxicillin: Case Report

Kundak¹,

Öner²,

Bağ³

et al. 2016

Turkiye Klinikleri J Dermatol

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184 laçla indüklenen hipersensitivite sendromu [Drug-induced hypersensitivity syndrome (DIHS)] adıyla da bilinen "Drug rash with eosinophilia and systemic symptoms (DRESS)" sendromu; ilaca bağlı akut ciddi bir ilaç aşırı duyarlılık sendromudur.1,2 Hidantoin ve türevlerinin antikonvül-zan tedavide kullanılmaya başlaması ile 1940'lı yıllarda sendromun isimlendirilme girişimleri başlamıştır. İlk isimlendirilmesi 1996 yılında Bacquet ve ark. tarafından ilk kez akronim şeklinde yapılmıştır. Eozinofili bu akronimde bulunmasına rağmen her zaman olması gerekli değildir.1-4 En sık hipersensitivite gelişimi bildirilen ilaçlar; antikonvülzanlar, sülfonamidler, Sülfasalazin ile Birlikte Amoksisilin Kullanımına Bağlı Gelişen DRESS Sendromu Ö ÖZ ZE ET T "Drug rash with eosinophilia and systemic symptoms (DRESS)" sendromu; nadir fakat yaşamı tehdit edici, çok ciddi, sistemik ilaç aşırı duyarlılık reaksiyonudur. Sendrom makülopapüler dö-küntü, ateş, lenfadenopati ve karaciğer, akciğer, kalp ve böbrek gibi organların tek ya da çoklu tutulumu ile klinik bulgu vermektedir. Sendromun patogenezi tam olarak anlaşılamamıştır. İlgili ilacın/ilaçların aktif metabolitlerinin üretimindeki veya detoksifikasyonundaki bozukluklar neticesinde aşırı duyarlılık reaksiyonunun tetiklenebileceği ileri sürülmektedir. Bu çalışmada, sülfasa-lazin ve amoksisiline bağlı DRESS sendromu gelişen 13 yaşındaki erkek olgu sunulmuş; seronegatif spondiloartrit nedeni ile yedi haftadır sülfasalazin ve tansillofarenjit nedeni ile üç gündür amoksisilin tedavisi almakta olan olgu, yaşamı tehdit edici gidişatı nedeni ile bu sendroma dikkat çekmek amacıyla sunulmuştur. Hızlı tanıyı takiben şüpheli ilacın/ilaçların hızla kesilmesi hastalığın tedavi edilebilmesinde tartışmasız tek yoldur.A An na ah ht ta ar r K Ke el li im me el le er r: : Eozinofili; ilaç aşırı duyarlılığı; sülfasalazin A AB BS ST TR RA AC CT T "Drug rash with eosinophilia and systemic symptoms" (DRESS) syndrome is a rare but life-threatening systemic severe adverse drug hypersensitive reaction. The syndrome is characterized by maculopapular rash, fever, lymphadenopathy and single or multiple organ involvement as liver, lung, heart and kidney. The pathogenesis of the syndrome is not clarified completely. It has been suggested that causative drug may induce hypersensitivity as a result of abnormalities in the production and detoxification of its active metabolites. In this report we aimed to present a 13 years old female with DRESS syndrome induced by sulfasalazine and amoxicillin. He had been taking sulfasalazine for seven weeks for treatment of seronegative spondylarthritis and taking amoxicillin for three days for tonsillopharyngitis. We want to remark to this syndrome because of its life-threatening course. Promt withdrawal of the offending drug/drugs following rapid diagnosis is only undisputed way to treat this syndrome.

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Isoniazid-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Presenting as Acute Eosinophilic Myocarditis

Cited by 17 publications

References 13 publications

Acute pericarditis in a young patient with IgG immunodeficiency

Acute pericarditis in a young patient with IgG immunodeficiency

Drug-Induced Eosinophilia

DRESS Syndrome Induced by Sulfasalazine with Amoxicillin: Case Report

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