Drug rash with eosinophilia and systemic symptoms syndrome

Background

DRESS syndrome-Drug Rash with Eosinophilia and Systemic Symptoms Syndrome is a severe adverse drug reaction that usually begins with 8 weeks of starting a new drug with a 8-10% mortality

Clinical Features

Fever, Rash (varying; may resemble SJS) are typically first signs
+/- lymphadenopathy
liver, kidney or hematologic system involvement
- atypical lymphocytes, thrombocytopenia
- Despite name, Eosinophilia in approx 30% of cases
Most commonly associated with phenytoin, phenobarbital,carbamezapine allopurinol and sulfa drugs
Other drugs: NSAIDS, anti-retrovirals, ACE-I, CCBs, other antibiotics

Differential Diagnosis

SJS/TENS
Kawasaki Disease
TTP

see Rashes

Workup

CBC with diff, BMP, biopsy (as inpt)

Management

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

Disposition

Admit

Sources

Tintaneli 7th ed p1617-1618
http://emedicine.medscape.com/article/1049474-overview
http://www.medscape.com/viewarticle/738548_4

Authors: