Variation of clinical manifestations according to culprit drugs in DRESS syndrome

Sim, Da Woon; Yu, Ji Eun; Jeong, Ji-Ung; Jung, Jae-Woo; Kang, Hye–Ryun; Kang, Dong Yoon; Ye, Young-Min; Jee, Young Koo; Kim, Sujeong; Park, Jung-Won; Kang, Min; Kim, Sae Hoon; Park, Hye Kyung; Yang, Min‐Suk; Hur, Gyu-Young; Lee, Jun Kyu; Choi, Jeong‐Hee; Kwon, Yong Eun; Koh, Young Youp

doi:10.1002/pds.4774

Cited by 31 publications

(37 citation statements)

References 37 publications

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“…A patient of HIV infection with CD4 count of 32 cells/μl did not develop fever, possibly because of poor immune response. Lymphadenopathy was present in 95% patients which was much higher than reported in literature 4,8,10‐12,15 …”

Section: Discussionmentioning

confidence: 65%

Drug reaction with eosinophilia and systemic symptoms: A single center descriptive observational study

Sandhu

Neema

Vashisht

et al. 2020

Dermatologic Therapy

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse cutaneous drug reaction with mortality up to 10%. It is a rare condition with risk varying between 1 in 1000 and 1 in 10 000 drug exposures. The aim of the study was to describe clinical features, management and drugs responsible for causing DRESS. The study was retrospective, observational study. The data of patients admitted to hospital with diagnosis of DRESS during study period (March 2018 to February 2020), were retrieved and analyzed. The descriptive data of patients were summarized. The continuous variables were summarized as mean ± SD and/or median, depending on the skewness of the data. The categorical variables were expressed as absolute numbers, frequency, and proportions (%). The data was tabulated and analyzed in Microsoft Excel 2019 version. A total of 20 patients who met inclusion criteria (probable or definite DRESS as per RegiSCAR criteria) were included in the study. The mean age of the patients was 41.2 ± 15.7 years. The average latency period was 26.45 ± 5.65 days (range: 7‐60). The commonest culprit drugs were dapsone and phenytoin, each in five (25%) patients. Commonest morphology of rash was morbilliform in 13 (65%) patients. One patient with targetoid rash had multi‐organ involvement. Facial edema, periorbital edema, and conjunctival injection were seen in 17 (85%), seven (35%), and six (30%) cases, respectively. Eosinophilia was present in 18 (90%) patients with mean (±SD) value of 1976 ± 840 cells/μl. Liver was the commonest internal organ involved in 14 (70%) patients and kidney in three (15%) patients. The initial dose of prednisolone for treatment varied from 0.75 to 2 mg/kg/day. The mean duration of steroid treatment was 64 ± 21 days. Two patients were treated with intravenous methylprednisolone and one with intravenous immunoglobulin. Two patients (10%) had recurrence of adverse drug reaction >6 months after completion of initial treatment and two (10%) developed autoimmune thyroiditis during follow‐up. Small sample size and retrospective nature of the study were main limitations. Selection bias is a possibility as study was carried out in tertiary care center. Tests for incriminating culprit drugs such as patch test, intradermal test, and lymphocyte transformation test were not performed. DRESS is a rare disease that can be diagnosed early with high index of suspicion and treated successfully with steroids. The internal organ involvement is common in DRESS and requires a thorough evaluation.

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Section: Discussionmentioning

confidence: 65%

Drug reaction with eosinophilia and systemic symptoms: A single center descriptive observational study

Sandhu

Neema

Vashisht

et al. 2020

Dermatologic Therapy

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“…Just 10 cases of DRESS syndrome with cephalosporins are reported until now (3.94% of all antibacterial antibiotic-reported DRESS cases) which most of them ( n = 8) caused by third-generation cephalosporins. However, in a retrospective study from Korea in 2018, cephalosporins besides vancomycin and anti-TB medication are reported as the most common antimicrobial agents inducing DRESS [ 35 ]. Cefotaxime was known to cause the fewest adverse reactions among beta-lactam antibiotics [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…The age of patients who experienced DRESS with vancomycin is mentioned to be higher than other culprit drugs [ 35 ]. Risk factors for vancomycin-induced DRESS are prolonged therapy with vancomycin (> 7 days) and age > 40 years [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

“…The fever is almost reported in all patients who experienced DRESS induced by dapsone. Hepatitis, lymphadenopathy, and atypical lymphocytosis were also common [ 35 ]. In nonleprosy patients, the HLA-B*13:01 allele was severely associated with dapsone-induced DRESS [ 74 ].…”

Section: Discussionmentioning

confidence: 99%

“…The liver was the main involved internal organ in DRESS induced by Pip/Taz [35]. It seems that DRESS induced by piperacillin is milder, with a benign course and favorable prognosis [21,22].…”

Section: Penicillinsmentioning

confidence: 99%

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Antibacterial antibiotic-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a literature review

Sharifzadeh

Mohammadpour

Tavanaee

et al. 2020

Eur J Clin Pharmacol

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Background Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) is a delayed infrequent potentially lifethreatening idiosyncratic drug reaction. Aromatic anticonvulsants and allopurinol are the most frequent causative agents. However, various reports of antibiotic-induced DRESS are available. In this review, we try to summarize reports of antibacterial antibiotic-induced DRESS focusing on characteristics of DRESS induced by each antibiotic group. Methods The data were collected by searching PubMed/MEDLINE and ScienceDirect. The keywords used as search terms were "DRESS syndrome," "drug-induced hypersensitivity syndrome (DIHS)," "antibiotics," "antimicrobial," and names of various antimicrobial groups. Finally, 254 relevant cases with a definite or probable diagnosis of DRESS based on RegiSCAR criteria were found until 30 May 2020 and reviewed. Results and conclusion Totally, 254 cases of antibacterial antibiotic-induced DRESS are reported. Most of them are related to antituberculosis drugs, vancomycin, and sulfonamides, respectively. Rash and fever were most frequent clinical findings. Eosinophilia and liver injury were the most reported hematologic and visceral organ involvement, respectively. Most of the patients are managed with systemic corticosteroids. The death occurred in 16 patients which most of them experienced liver or lung involvement. The reactivation of various viruses especially HHV-6 is reported in 33 cases. The mean latency period was 29 days. It is necessary to perform thorough epidemiological, genetic, and immunological studies, also systematic case review and causality assessment, as well as well-designed clinical trials for better management of antibiotic-induced DRESS.

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DRESS characteristics according to the causative medication

Chaabane

Romdhane

Fadhel

et al. 2022

Eur J Clin Pharmacol

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Variation of clinical manifestations according to culprit drugs in DRESS syndrome

Cited by 31 publications

References 37 publications

Drug reaction with eosinophilia and systemic symptoms: A single center descriptive observational study

Drug reaction with eosinophilia and systemic symptoms: A single center descriptive observational study

Antibacterial antibiotic-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a literature review

DRESS characteristics according to the causative medication

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