Prevalence, risk factors, and mortality outcome in the drug reaction with eosinophilia and systemic symptoms patients with cardiac involvement

Intarasupht, Julphat; Kanchanomai, Anchisa; Leelasattakul, Wuttirak; Chantrarat, Thoranis; Nakakes, Artit; Tiyanon, Waraporn

doi:10.1111/ijd.14174

Cited by 19 publications

(25 citation statements)

References 19 publications

(53 reference statements)

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“…The general consensus is that DS has no sex predilections. Some studies reported female predominance [57,58], while others reported DS being more common in the male population [7]. Our data showed female predominance (61.9%), but mortality was not associated with gender.…”

Section: Age and Sexcontrasting

confidence: 43%

“…Prior studies of DS have reported a relatively low incidence of cardiac involvement in DRESS (11 of 83 patients, 13.3%): Intarasupht et al [7] described cardiac manifestations in 8 out of 41 patients (20%) diagnosed with DS in Bangkok, Thailand hospital over a 5-year period; Eshki et al [36] conducted a retrospective study in France over the span of 12 years and found cardiac involvement in only 2 out 15 patients (13%) diagnosed with DS; Ang et al [49] reported only 1 case of myocarditis out of 27 analyzed patients (4%) diagnosed with DIHS over a 5-year period in Singapore hospital.…”

Section: Discussionmentioning

confidence: 98%

“…Mortality in DS depends on the extent of visceral organ involvement and death usually results from liver failure, respiratory failure, and/or fulminant myocarditis [6]. Mortality seems to be particularly high in patients who develop cardiac manifestations, with 50% of patients dying within 60 days from symptom onset [7].…”

Section: Introductionmentioning

confidence: 99%

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“Heart in DRESS”: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review

Radovanovic

Jevtic

Calvin

et al. 2022

JCM

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Cardiac involvement in drug reaction with eosinophilia and systemic symptoms (DS) is rare but associated with high mortality. The aim of this research was to systematically review case reports by PRISMA guidelines in order to synthetize the knowledge of cardiac manifestations of DS. We identified 42 cases from 36 case reports. Women were two times more affected than men. Two-thirds of patients had cardiac manifestation in the initial phase of the disease, while in one-third of cases cardiac manifestations developed later (mean time of 70 ± 63 days). The most common inciting medications were minocycline (19%) and allopurinol (12%). In 17% of patients, the heart was the only internal organ affected, while the majority (83%) had at least one additional organ involved, most commonly the liver and the kidneys. Dyspnea (55%), cardiogenic shock (43%), chest pain (38%), and tachycardia (33%) were the most common cardiac signs and symptoms reported. Patients frequently had an abnormal ECG (71.4%), and a decrease in left ventricular ejection fraction was the most common echocardiographic finding (45%). Endomyocardial biopsy or histological examination at autopsy was performed in 52.4%, with the predominant finding being fulminant eosinophilic myocarditis with acute necrosis in 70% of those biopsied. All patients received immunosuppressive therapy with intravenous steroids, while non-responders were more likely to have received IVIG, cyclosporine, mycophenolate, and other steroid-sparing agents (60%). Gender and degree of left ventricular systolic dysfunction were not associated with outcomes, but short latency between drug exposure and the first DRESS symptom onset (<15 days) and older age (above 65 years) was associated with death. This underscores the potential importance of heightened awareness and early treatment.

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Section: Age and Sexcontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 98%

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“Heart in DRESS”: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review

Radovanovic

Jevtic

Calvin

et al. 2022

JCM

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“…Norepinephrine and dobutamine were completely withdrawn, while milrinone was intentionally fixed at a low dose. Overall, the most common arrhythmias were sinus tachycardia and right bundle branch block ( Table 2), [5][6][7][8][9]11,12,14,[16][17][18][21][22][23][25][26][27][28][29][30]32,[37][38][39][40][41][43][44][45][46][47][48][49][50][51][52][53] usually appearing as initial rhythms on admission. On the contrary, ventricular arrhythmias and complete heart block mostly happened late in the clinical course.…”

Section: Case Presentationmentioning

confidence: 99%

“…By searching the PubMed database using the keywords 'DRESS' or 'drug-induced hypersensitivity syndrome' and 'myocarditis', as of August 2020, we identified 63 reported cases of DRESS-associated myocarditis in the literature: 43 case reports, four case series, 48-51 and three small observational studies [52][53][54]. The incidence of DRESS-associated myocarditis ranged from one to five cases per year(Figure 3).…”

mentioning

confidence: 99%

Prolonged Extracorporeal Membrane Oxygenation Support In a Patient with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome-associated Fulminant Myocarditis – A Case Report and Literature Review

Seree-aphinan¹,

Assanangkornchai²,

Nilmoje³

2020

Heart International

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Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms

Brüggen,

Walsh,

Ameri

et al. 2024

JAMA Dermatol

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ImportanceDrug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. To our knowledge, there is no international consensus on its severity assessment and treatment.ObjectiveTo reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS.Design, Setting, and ParticipantsThe Delphi method was used to assess 100 statements related to baseline workup, evaluation of severity, acute phase, and postacute management of DRESS. Fifty-seven international experts in DRESS were invited, and 54 participated in the survey, which took place from July to September 2022.Main Outcomes/MeasuresThe degree of agreement was calculated with the RAND-UCLA Appropriateness Method. Consensus was defined as a statement with a median appropriateness value of 7 or higher (appropriate) and a disagreement index of lower than 1.ResultsIn the first Delphi round, consensus was reached on 82 statements. Thirteen statements were revised and assessed in a second round. A consensus was reached for 93 statements overall. The experts agreed on a set of basic diagnostic workup procedures as well as severity- and organ-specific further investigations. They reached a consensus on severity assessment (mild, moderate, and severe) based on the extent of liver, kidney, and blood involvement and the damage of other organs. The panel agreed on the main lines of DRESS management according to these severity grades. General recommendations were generated on the postacute phase follow-up of patients with DRESS and the allergological workup.Conclusions and RelevanceThis Delphi exercise represents, to our knowledge, the first international expert consensus on diagnostic workup, severity assessment, and management of DRESS. This should support clinicians in the diagnosis and management of DRESS and constitute the basis for development of future guidelines.

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Prevalence, risk factors, and mortality outcome in the drug reaction with eosinophilia and systemic symptoms patients with cardiac involvement

Cited by 19 publications

References 19 publications

“Heart in DRESS”: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review

“Heart in DRESS”: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review

Prolonged Extracorporeal Membrane Oxygenation Support In a Patient with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome-associated Fulminant Myocarditis – A Case Report and Literature Review

Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms

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