Drug rash with eosinophilia and systemic symptoms syndrome

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Background

  • Known as DRESS syndrome
  • A severe adverse drug reaction
  • Usually begins within 8 weeks of starting a new drug
  • 8-10% mortality
  • Previously known as Dilantin Hypersensitivity Syndrome or Anti-convulsant hypersensitivity syndrome
  • However, many other medications, particularly antibiotics

Associated Drugs

Clinical Features

Differential Diagnosis

  • SJS/TENS
  • Kawasaki Disease
  • TTP
  • See Rashes

Evaluation

  • CBC with diff
  • BMP
  • Biopsy

Management

  • Discontinue suspected drug
  • Supportive care: anti-pyretic, anti-puritic
  • Systemic steroids in severe cases (controversial)
    • hepatitis, pneumonitis, extensive exfoliative dermatitis
  • Family counseling as possible genetic component

Disposition

  • Admit

See Also

External Links

References

  1. Herman AO. Antipsychotic Linked to Potentially Fatal Skin Reaction. Physician's First Watch. Dec 12, 2014. http://www.jwatch.org/fw109630/2014/12/12/antipsychotic-linked-potentially-fatal-skin-reaction?query=pfw&jwd=000013530619&jspc=.

Authors

Neil Young