Drug rash with eosinophilia and systemic symptoms syndrome: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
(Text replacement - "CCBs" to "calcium-channel blockers") |
||
| Line 18: | Line 18: | ||
**anti-retrovirals | **anti-retrovirals | ||
**ACE-I | **ACE-I | ||
** | **calcium-channel blockers | ||
**Atypical antipsychotics ([[ziprasidone]], [[olanzapine]], etc.)<ref>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=.</ref> | **Atypical antipsychotics ([[ziprasidone]], [[olanzapine]], etc.)<ref>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=.</ref> | ||
**other [[antibiotics]] | **other [[antibiotics]] | ||
Revision as of 01:17, 4 August 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
- calcium-channel blockers
- Atypical antipsychotics (ziprasidone, olanzapine, etc.)[1]
- 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
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
- ↑ 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=.