Drug rash with eosinophilia and systemic symptoms syndrome: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*[[Fever]] and [[rash]] (varying; may resemble [[SJS]]) are typically first signs | *[[Fever]] and [[rash]] (varying; may resemble [[SJS]]) are typically first signs | ||
**Usually urticarial, maculopapular eruption | |||
**In some cases vesicles, bullae, pustules, purpura, target lesions, facial edema, cheilitis, erythroderma | |||
*+/- lymphadenopathy | *+/- lymphadenopathy | ||
* | *Systemic involvement may manifest as hepatitis, pneumonitis, myocarditis, pericarditis, nephritis, colitis | ||
**Atypical lymphocytes, [[thrombocytopenia]] | **Atypical lymphocytes, [[thrombocytopenia]] | ||
** | **Leukocytosis with [[eosinophilia]] in 90% | ||
, and mononucleosis in 40%<ref>Callot V, Roujeau JC, Bagot M, et al. Drug-induced pseudolymphoma and hypersensitivity syndrome. Two different clinical entities. Arch Dermatol. 1996;132:1315–1321.</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 23:08, 24 February 2019
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
- A virus-drug interaction with HHV-6, HHV-7, EBV, and CMV may be a form of pathogenesis as well[1]
Associated Drugs
- Most common
- Phenytoin
- Phenobarbital
- Carbamazepine
- Allopurinol
- Sulfa drugs
- Others
- NSAIDS
- Anti-retrovirals
- ACE inhibitors
- Calcium-channel blockers
- Atypical antipsychotics (ziprasidone, olanzapine, etc.)[2]
- Other antibiotics
Clinical Features
- Fever and rash (varying; may resemble SJS) are typically first signs
- Usually urticarial, maculopapular eruption
- In some cases vesicles, bullae, pustules, purpura, target lesions, facial edema, cheilitis, erythroderma
- +/- lymphadenopathy
- Systemic involvement may manifest as hepatitis, pneumonitis, myocarditis, pericarditis, nephritis, colitis
- Atypical lymphocytes, thrombocytopenia
- Leukocytosis with eosinophilia in 90%
, and mononucleosis in 40%[3]
Differential Diagnosis
- SJS/TENS
- Kawasaki Disease
- TTP
- See Rashes
Evaluation
- CBC with diff
- BMP
- LFTs
- Coags
- ESR
- CRP
- Viral hepatitis panel
- 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
- ↑ Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome. Sonal Choudhary, Michael McLeod, Daniele Torchia, Paolo Romanelli. J Clin Aesthet Dermatol. 2013 Jun; 6(6): 31–37.
- ↑ 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=.
- ↑ Callot V, Roujeau JC, Bagot M, et al. Drug-induced pseudolymphoma and hypersensitivity syndrome. Two different clinical entities. Arch Dermatol. 1996;132:1315–1321.