Drug rash with eosinophilia and systemic symptoms syndrome: Difference between revisions
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*CBC with diff | *CBC with diff | ||
*BMP | *BMP | ||
*Biopsy | *Biopsy | ||
==Management== | ==Management== |
Revision as of 11:46, 4 May 2016
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[citation needed]
Differential Diagnosis
- SJS/TENS
- Kawasaki Disease
- TTP
- See Rashes
Diagnosis
- 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