Pediatric drug reaction with eosinophilia and systemic symptoms: A systematic review of the literature

Abstract

Background Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction including integumentary and internal organs. An extensive literature review of DRESS in the pediatric population has not been performed. Methods A literature search was performed to find reports of pediatric DRESS published between 1997 and March 2019. If not already included, each case was scored based on RegiSCAR criteria. Only “probable” or “definite” cases of DRESS were included in the analysis, totaling 130 cases. Results In the pediatric population, the average age of diagnosis for DRESS was 8.7 years old. The most common causative drugs include antiepileptics (50%) and antibiotics (30.8%). Time from drug exposure to DRESS presentation averaged 23.8 days. Common clinical symptoms include rash (99.2%) (typically morbilliform (89.2%)), fever (96.2%), eosinophilia (90%), and lymphadenopathy (74.6%). Human herpesvirus‐6 reactivation was observed in 16.1% of cases. The most commonly affected internal organ was the liver (80%), followed by the spleen (21.5%) and kidney (15.4%). Management strategies involved, either alone or in combination, included corticosteroids (intravenous 60.8% and oral 41.5%), intravenous immunoglobulins (12.3%), plasmapheresis (2.3%), and ganciclovir (1.5%). Long‐term sequelae occurred in 10.8% of patients, most commonly hypothyroidism (3.8%), liver failure (3.1%), and diabetes (2.3%). The mortality rate was 5.4%. Conclusion This literature review highlights the presentation and course of pediatric DRESS. Morbilliform eruption, fever, and eosinophilia appear to be clinical hallmarks of pediatric DRESS. Common causative agents, specifically carbamazepine, are comparable to the adult population. Furthermore, the mortality rate from DRESS is significant and is similar between pediatric and adult patients.

Pediatric drug reaction with eosinophilia and systemic symptoms: A systematic review of the literature, with a focus on relapsing cases

“…Our results are consistent with recently published systematic reviews on pediatric DRESS concerning the severity of the disease and its management. 9,10 However, DRESS often has a long course characterized by multiple episodes of complete or partial relapses or flares, despite withdrawing the culprit drug. 2,11,12 Reactivation of cutaneous symptoms during the first months following DRESS episode often occurs in a less severe form and in a shorter delay following drug exposure.…”

Infectious exanthemas in childhood

“…This starts as a maculopapular exanthema at least three weeks after first intake of the causative drug (mainly anticonvulsants, antibiotics, allopurinol). The exanthema will rapidly progress to exfoliative dermatitis ( Figure 12) and is accompanied by systemic symptoms such as fever, increased liver enzymes, eosinophilia, and lymphadenopathy [67].…”

Síndrome de Reacción a drogas con Eosinofilia y Síntomas Sistémicos (DRESS) asociados a Nefritis Túbulo Intersticial Aguda en un adolescente

“…La incidencia en población pediátrica no está bien establecida, pero se estima que la entidad se presenta entre 1:1000 a 1:10000 exposiciones a medicamentos, siendo los anticonvulsivantes (50%) y antibióticos (30,8%) las causas más comunes, con reportes de tasas de mortalidad hasta del 10% (3,5,9,11).…”