Severe DRESS Syndrome Managed With Therapeutic Plasma Exchange

Alexander, Thomas; Iglesia, Edward G.A.; Park, Yara; Duncan, Daniel R.; Peden, David B.; Sheikh, Saira Z; Ferris, Maria

doi:10.1542/peds.2012-2117

Cited by 34 publications

(29 citation statements)

References 35 publications

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“…Since then, several reports have recommended alternative treatment options, for second-line use. Drugs such as cyclosporine, intravenous immunoglobulins, mycophenolate mofetil, cyclophosphamide, and plasmapheresis have been evaluated as alternatives [10][11][12][13]. Since viral reactivation is thought to play a role in the pathogenesis of DRESS syndrome, some experts have recommended the use of antivirals, such as ganciclovir, along with steroid treatment [14].…”

Section: Discussionmentioning

confidence: 99%

Lamotrigine-induced DRESS Syndrome Manifesting as ‘Eosinophilic Colitis’: An Uncommon Presentation of a Very Uncommon Condition

Parsi¹,

Daniel²

2020

Cureus

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare drug-induced hypersensitivity reaction that manifests with a variety of signs and symptoms. It is an important condition that must be recognized by all physicians because if untreated, it can be fatal. There are a variety of medications that are responsible for this condition. The liver, lungs, and kidneys are commonly affected, with the involvement of the gastrointestinal tract being very rare; only a few cases are reported worldwide. We are presenting a case of lamotrigineinduced DRESS syndrome manifesting as colitis. A 32-year-old female presented with diarrhea, two weeks after the initiation of lamotrigine. Her condition worsened with the development of a generalized rash and bloody diarrhea. Further investigations revealed that she likely had a drug reaction secondary to lamotrigine. Fortunately, prompt initiation of systemic steroids led to the resolution of her symptoms.

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Section: Discussionmentioning

confidence: 99%

Lamotrigine-induced DRESS Syndrome Manifesting as ‘Eosinophilic Colitis’: An Uncommon Presentation of a Very Uncommon Condition

Parsi¹,

Daniel²

2020

Cureus

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“…Nevertheless, the most widely accepted and used treatment is systemic corticosteroids . There are case reports of successful treatment with plasma exchange, intravenous immunoglobulins, cyclosporine, and N‐acetylcysteine . All our patients were treated with either oral or intravenous corticosteroids, with two treated with intravenous pulsed methylprednisolone.…”

Section: Discussionmentioning

confidence: 99%

Drug reaction with eosinophilia and systemic symptoms in a cohort of Asian children

Han

Koh

Wong

2019

Pediatric Dermatology

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Background/objectives: Drug reaction with eosinophilia and systemic symptoms (DRESS) is rare but potentially fatal in children. Fever and rash, which are salient features of DRESS, may mimic other commonly encountered pediatric conditions. We profiled the DRESS cases in a tertiary children's hospital in Singapore. Methods:The medical records of all pediatric DRESS patients diagnosed from 2006 to 2016. Data on epidemiology, inciting drugs, clinical, pathologic manifestations, and treatment were assessed.Results: Ten patients aged 4-16 years old were diagnosed with DRESS within the 10year period. Drugs implicated were antibiotics, such as trimethoprim-sulfamethoxazole, and anticonvulsants, such as carbamazepine, phenobarbitone, and levetiracetam. All patients had fever and pruritic exanthems. Desquamation, purpura, and oral mucositis were also observed. Lymphadenopathy, hepatomegaly, and facial edema occurred frequently. There was liver involvement in all cases, but none progressed to liver failure.Seven patients had eosinophilia, and nine had atypical lymphocytosis. Other laboratory abnormalities included low hemoglobin, thrombocytosis, and prolonged coagulation times. All patients received systemic corticosteroids of varying durations and dosages.

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“…4 Recently implicated psychotropic drugs include benzodiazepines, bupropion, mirtazapine, and amitriptyline. [5][6][7][8][9] Most studies have focused on aromatic antiepileptics, including phenytoin (PHT), carbamazepine (CBZ), and phenobarbital (PB), but little is known about psychotropic drugeinduced DRESS syndrome. Moreover, consensus has not been established on the management and treatment of DRESS syndrome.…”

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confidence: 99%

Management of Psychotropic Drug–Induced DRESS Syndrome: A Systematic Review

Bommersbach

Lapid

Leung

et al. 2016

Mayo Clinic Proceedings

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Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous eruption that has been linked to several common drugs and drug categories, including antiepileptics, allopurinol, sulfonamides, and various antibiotics; however, because of a number of recent case reports linking psychotropic medications to this condition, DRESS is increasingly recognized among psychiatrists. We systematically reviewed all psychotropic drugs linked to DRESS syndrome, and this article summarizes the clinical management relevant to psychiatric professionals. A comprehensive search was performed using Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Litt's Drug Eruption and Reaction Database for articles published in English during the past 20 years (1996-2015) using the search terms (1) psychotropic drugs OR serotonin uptake inhibitors AND DRESS or (2) psychotropic drugs AND drug reaction (or rash) eosinophilia systemic syndrome, and all article abstracts were screened for inclusion and exclusion criteria by 3 reviewers. Two independent reviewers examined the full text of 163 articles, of which 96 (25 original articles, 12 review articles, 55 case reports, and 4 letters to the editor) were included in the systematic review. We identified 1072 cases of psychotropic drug-induced DRESS, with carbamazepine, lamotrigine, phenytoin, valproate, and phenobarbital being the most implicated drugs. Based on our review of the literature, we outline management principles that include prompt withdrawal of the causative drug, hospitalization, corticosteroid therapy, and novel treatments, including intravenous immunoglobulin, cyclophosphamide, and cyclosporine, for corticosteroid-resistant DRESS. Finally, we outline strategies for treating comorbid psychiatric illness after a DRESS reaction to the psychotropic medication.

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Severe DRESS Syndrome Managed With Therapeutic Plasma Exchange

Cited by 34 publications

References 35 publications

Lamotrigine-induced DRESS Syndrome Manifesting as ‘Eosinophilic Colitis’: An Uncommon Presentation of a Very Uncommon Condition

Lamotrigine-induced DRESS Syndrome Manifesting as ‘Eosinophilic Colitis’: An Uncommon Presentation of a Very Uncommon Condition

Drug reaction with eosinophilia and systemic symptoms in a cohort of Asian children

Management of Psychotropic Drug–Induced DRESS Syndrome: A Systematic Review

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