drug eruption with eosinophilia & systemic symptoms
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Etiology
- see morbilliform drug eruption
- pharmaceuticals
Epidemiology
- rare
Pathology
- type B drug reaction
- liver, kidney & lungs may be involved
- skin biopsy: lymphocytic infiltration, edema
Clinical manifestations
- signs/symptoms begin 5-10 days (2-6 weeks[6]) after starting offending drug
- morbilliform drug eruption (rash)
- fever
- facial edema
- lymphadenopathy
- hepatomegaly
* images[5]
Laboratory
- complete blood count*
- atypical lymphocytosis, eosinophilia
- liver function tests*
- skin biopsy
- useful for confirmation of diagnosis
- not helpful for assessing severity of systemic involvement
- lymph node biopsy is rarely required for diagnosis[1]
* essential testing for suspected DRESS syndrome
Complications
- hepatotoxicity progressing to liver failure even if rash resolves
- mortality 5%[2]
Differential diagnosis
- Stevens-Johnson syndrome (lymphadenopathy not a feature)
Management
- potentially life-threatening
- hospitalize
- discontinue offending agent
- systemic glucocorticoids may be needed
More general terms
References
- ↑ Jump up to: 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
- ↑ Jump up to: 2.0 2.1 Cacoub P, Musette P, Descamps V et al The DRESS syndrome: a literature review. Am J Med. 2011 Jul;124(7):588-97 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21592453
- ↑ NEJM Knowledge+
Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: Part I. Clinical perspectives. J Am Acad Dermatol. 2013 May;68(5):693.e1-14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23602182
Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: Part II. Management and therapeutics. J Am Acad Dermatol. 2013 May;68(5):709.e1-9; quiz 718-20. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23602183 - ↑ Buck ML Medscape: DRESS Syndrome http://www.medscape.com/viewarticle/776164
- ↑ Jump up to: 5.0 5.1 DermNet NZ. Drug hypersensitivity syndrome. (images) http://www.dermnetnz.org/reactions/drug-hypersensitivity-syndrome.html
- ↑ Jump up to: 6.0 6.1 Chen YC, Chiu HC, Chu CY Drug reaction with eosinophilia and systemic symptoms: a retrospective study of 60 cases. Arch Dermatol. 2010 Dec;146(12):1373-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20713773