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

Abstract

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction with systemic symptoms. This study aims to investigate clinical features, causative drugs, and available treatments for pediatric DRESS, particularly for relapsing cases. Methods: A systematic search of the English and French literature on pediatric DRESS was conducted using the Medline, Embase, and Cochrane collaboration databases. Confirmed cases of pediatric DRESS fulfilling the RegiSCAR diagnostic criteria with a probable or a definite diagnosis were included. Results: After full-text article review, 144 articles were included, representing a total of 354 pediatric patients with a mean age of 8.8 years. The mean time from the drug intake until the onset of the first symptom was 18.9 days. Antiepileptic drugs were the main trigger, followed by anti-infectious agents. Relapsing DRESS was reported in 17 children. In comparison to non-relapsing cases, relapsing patients had more comorbidities. The initial clinical presentation was more commonly erythroderma. Facial edema, fever, and enlarged lymph nodes in more than two sites were more commonly found in relapsing cases. Systemic steroids were more frequently administered. Conclusion: Pediatric DRESS is a potentially severe adverse drug reaction. Antiepileptic agents are the most common causative agents. Fever, facial edema, lymph node enlargement, and pharyngeal and visceral involvement predicted DRESS reactivation in children. Corticosteroids were the mainstay of treatment.

Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome in a Child with Cystic Fibrosis

“…In our case, piperacillin-tazobactam and amikacin were the potential inciting drugs for DRESS syndrome. Moris et al reported piperacillin-tazobactam in only two of the 103 cases of DRESS syndrome (2%) but was rarely reported by others [ 1 , 5 , 11 ]. To the best of our knowledge, amikacin has not been reported as a triggering drug for DRESS syndrome.…”

“…In mild disease (no organ involvement or only mild liver involvement), treatment is symptomatic. Systemic corticosteroids, immunosuppressive medications, and intravenous immunoglobulins are reserved for severe cases with significant visceral organ injury, particularly renal and/or pulmonary involvement [ 1 , 11 ]. In our patient, progressive resolution of clinical features and laboratory abnormalities (inflammatory markers, eosinophils, and decrease in hepatic enzymes) was observed within two days of ceasing piperacillin-tazobactam and amikacin treatment, highlighting the importance of early recognition and prompt removal of inciting drugs to avoid harmful outcomes associated with DRESS syndrome.…”

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

“…DRESS is a complex disorder characterized by the onset of severe dermatological lesions along with hypersensitivity features, and the involvement of an internal organ, frequently the liver [65]. 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].…”

Síndrome de reacción a fármaco con eosinofilia y síntomas sistémicos en un niño con fibrosis quística

“…En nuestro caso, la piperacilina-tazobactam y la amikacina fueron los posibles fármacos desencadenantes del síndrome DRESS. Moris et al señalaron la presencia de piperacilina-tazobactam en sólo dos de los 103 casos de síndrome DRESS (2%), pero otros autores lo reportaron en raras ocasiones [1, 5, 11]. Hasta donde sabemos, no se ha reportado que la amikacina sea un fármaco desencadenante del síndrome DRESS.…”

“…En los casos leves (sin afectación orgánica o con afectación hepática leve), el tratamiento es sintomático. Los corticosteroides sistémicos, los medicamentos inmunosupresores y la administración intravenosa de inmunoglobulinas se reservan para los casos graves, con lesión significativa de órganos viscerales, especialmente compromiso renal y/o pulmonar [1, 11]. En nuestro paciente se observó una resolución progresiva de las características clínicas y las anomalías de laboratorio (marcadores inflamatorios, eosinófilos y disminución de las enzimas hepáticas) a los dos días de suspender el tratamiento con piperacilina-tazobactam y amikacina, lo que pone de relieve la importancia de un reconocimiento temprano y un rápido cese de los fármacos desencadenantes.…”