Trimetazidine, a hitherto unreported cause of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome

Singh, Sweta; Khurana, Ananta; Muddebihal, Aishwarya; Jangra, Manish

doi:10.1111/cod.13715

Cited by 3 publications

(1 citation statement)

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“…Analysis revealed the presence of interstitial nephritis in most cases of DS reviewed seen with granulomatous lesions, tubular atrophy, interstitial fibrosis, infiltration of mononuclear cells, eosinophils, lymphocytes, macrophages, and plasmocytes [14,15,17,20,22,23,31,32,36,39,41,43,50,56,63,64,69,77]. Tubular necrosis and vasculitis in some renal vessels were also observed [82].…”

Section: Renal Biopsy Findingsmentioning

confidence: 98%

Renal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of 71 Cases

Dagnon da Silva,

Domingues,

Oluic

et al. 2023

JCM

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Unlike other adverse drug reactions, visceral organ involvement is a prominent feature of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and correlates with mortality. The aim of this study was to systematically review cases published in PubMed-indexed, peer-reviewed journals in which patients had renal injury during the episode of DRESS syndrome (DS). We found 71 cases, of which 67 were adults and 56% were males. Female sex was associated with higher mortality. Chronic kidney disease (CKD) was present in 14% of patients who developed acute kidney injury (AKI) during DS. In 21% of cases, the kidneys were the only visceral organ involved, while 54% of patients had both liver and kidney involvement. Eosinophilia was absent in 24% of patients. The most common classes of medication associated with renal injury in DS were antibiotics in 34%, xanthine oxidase inhibitors in 15%, and anticonvulsants in 11%. Among antibiotics, vancomycin was the most common culprit in 68% of patients. AKI was the most common renal manifestation reported in 96% of cases, while isolated proteinuria or hematuria was present in only 4% of cases. In cases with AKI, 88% had isolated increase in creatinine and decrease in glomerular filtration (GFR), 27% had AKI concomitantly with proteinuria, 18% had oliguria, and 13% had concomitant AKI with hematuria. Anuria was the rarest manifestation, occurring in only 4% of patients with DS. Temporary renal replacement therapy was needed in 30% of cases, and all but one patient fully recovered renal function. Mortality of DS in this cohort was 13%, which is higher than previously reported. Medication class, latency period, or pre-existing CKD were not found to be associated with higher mortality. More research, particularly prospective studies, is needed to better recognize the risks associated with renal injury in patients with DS. The development of disease-specific biomarkers would also be useful so DS with renal involvement can be easier distinguished from other eosinophilic diseases that might affect the kidney.

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Section: Renal Biopsy Findingsmentioning

confidence: 98%

Renal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of 71 Cases

Dagnon da Silva,

Domingues,

Oluic

et al. 2023

JCM

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Trimetazidine

2021

Reactions Weekly

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DRESS syndrome with impaired renal function: case reportA 64-year-old woman developed DRSS syndrome with impaired renal function during treatment with trimetazidine for deteriorating angina.The woman presented to the dermatology unit a 2-week history of generalised redness, scaling and pruritus associated with fever. She had dilated cardiomyopathy and was on treatment with aspirin, carvedilol and torasemide [torsemide] for 10 years. Additionally, she had been receiving trimetazidine [route and dosage not stated] 6 weeks prior to the presentation in view of her deteriorating angina. On examination, she was febrile and had exfoliative dermatitis involving more than 90% of her body surface area, facial oedema, hemorrhagic crusting over her lips and oedema of the distal extremities. There was significant lymphadenopathy in the bilateral cervical and axillary regions but no palpable hepatosplenomegaly. On investigation, she had eosinophilia and impaired renal function. Serology for hepatitis B and C viruses was negative. Her total leukocyte count was 5600 /mm 3 and lymphocytes were 1800 /mm 3 with no atypical lymphocytes on peripheral smear. Complement levels and liver functions were normal, antinuclear antibody (ANA) was negative, urine examination was essentially normal and chest x-ray showed no abnormality. There was no history of pre-existing dermatoses, and her previous renal function tests, performed routinely every 6 months, showed no abnormality. A diagnosis of DRESS with renal involvement, possibly induced by trimetazidine, was considered.The woman received prednisolone along with fluid and electrolyte management, high protein diet, Condy's compresses and paraffin gauze dressings, and topical antibiotics over eroded surfaces. In view of the poor renal function, dialysis was performed on the day of admission and again on days 1 and 4 of admission. Because renal function deterioration had been acute, with normal documented renal function beforehand, and she was older and had multiple comorbidities, a renal biopsy was not attempted. Her skin condition started improving with discontinuation of the presumed culprit drug trimetazidine, whereas aspirin, carvedilol and torasemide were continued. Prednisolone was gradually tapered over 6 weeks of hospital stay. Her renal condition gradually improved over this time and normalised at the time of discharge.

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