Drug rash with eosinophilia and systemic symptoms syndrome

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

• Most common
  • phenytoin
  • phenobarbital
  • carbamezapine
  • allopurinol
  • sulfa drugs
• Others
  • NSAIDS
  • anti-retrovirals
  • ACE-I
  • CCBs
  • other antibiotics

Clinical Features

• Fever and rash (varying; may resemble SJS) are typically first signs
• +/- lymphadenopathy
• liver, kidney or hematologic system involvement
  • atypical lymphocytes, thrombocytopenia
  • Despite name, eosinophilia only in ~30% of cases

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)
  • hepatitis, pneumonitis, extensive exfoliative dermatitis
• Family counseling as possible genetic component

Disposition

Admit

See Also

• Rashes

Sources

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