Successful Treatment of Sulfasalazine‐Induced DRESS Syndrome with Corticosteroids and N‐Acetylcysteine

Abstract

Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare, severe drug hypersensitivity syndrome characterized by fever, rash, hematologic abnormalities, and systemic involvement. The pathogenesis of DRESS is unclear, but it is thought that the offending drug induces an immune mediated hypersensitivity via defects in metabolism. Severe cases of DRESS often require aggressive treatment, but current pharmacologic treatment options are limited. We report a 66 year old female who presented with fever and rash three weeks after starting sulfasalazine treatment for rheumatoid arthritis. Investigation revealed diffuse lymphadenopathy, leukocytosis, eosinophilia, and hepatitis. She was diagnosed with DRESS, sulfasalazine was discontinued, and she was treated with methylprednisolone. Her condition deteriorated,

Drug rash with eosinophilia and systemic symptoms syndrome associated with use of phenytoin, divalproex sodium, and phenobarbital

“…2 Further complicating the clinical picture, flare-ups of symptoms in cases presumed to be resolving have been reported. 8 Cross-sensitivity among the aromatic anticonvulsants has been reported to be as high as 80%. 5 In two case reports, patients who had previously tolerated phenytoin therapy, with no drug-related rash, required a switch to carbamazepine therapy during subsequent episodes of care due to an increase in the occurrence of seizure.…”

Fatal Clindamycin‐Induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome

“…In addition, the only other published case report of clindamycin‐induced DRESS syndrome described a successful clinical outcome with corticosteroid therapy . N‐ Acetylcysteine was also used successfully as an adjunct to corticosteroid treatment in a patient with sulfasalazine‐induced DRESS syndrome . Given the delay in the diagnosis of DRESS syndrome in our patient, corticosteroid treatment was not administered.…”

N-Acetylcysteine Uses in Dermatology Traditional Compilation: Traditional Review

“…Erken verildiğinde daha etkili bulunmuştur. [16][17][18] Lite-ratürde toplam 4 vaka bilidirlmiştir (kanıt düzeyi 4). DRESS sendromu için NAC kullanımını desteklemek veya buna karşı çıkmak için şu anda yetersiz randomize kontrollü veri bulunmaktadır.…”