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Less Known Gastrointestinal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of the Literature. J Clin Med 2021; 10:jcm10184287. [PMID: 34575398 PMCID: PMC8467470 DOI: 10.3390/jcm10184287] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life threatening severe cutaneous drug reaction. Most patients develop eosinophilia, a rash, a fever, lymphadenopathy and variable visceral organ involvement 2–6 weeks following exposure to the inciting medication. Unlike other severe cutaneous drug reactions, internal organ involvement that leads to high mortality is a unique feature of DRESS syndrome. While the liver is the most common internal organ involved, literally every other visceral organ can be affected in this syndrome. The lesser-known gastrointestinal manifestations of this syndrome include esophagitis, gastritis, enteritis, colitis, pancreatitis and a late autoimmune sequela due to pancreatic injury such as fulminant type 1 diabetes mellitus, autoimmune type 1 diabetes mellitus and type 2 diabetes mellitus. While these entities are less common, they are associated with equally severe complications and adverse patient outcomes. In this review, we synthetize data on these rare manifestations using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The liver, the most common visceral organ involved, has been described as part of DRESS elsewhere and is not included in the scope of this article.
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Characterizing DRESS syndrome recurrence: a systematic review. Arch Dermatol Res 2021; 314:721-728. [PMID: 34505944 DOI: 10.1007/s00403-021-02274-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
Recurrence of DRESS syndrome is poorly characterized, and dermatologists must be prepared to predict, identify, and manage patients after treatment of the initial presentation. In this study, a primary literature search was conducted using PubMed, capturing all articles recording cases of DRESS syndrome recurrence. Forty-two articles were included for review comprising a total of 60 patients. The average age of patients was 46.3 years and time to recurrence was 123 days. Recurrent episodes presented more frequently with a higher fever and eosinophil absolute peak. Relapse was most often attributed to the introduction of a new medication (n = 18). Of the 17 cases in which outcome data were available, the survival rate of those experiencing recurrence was 71%. Viral reactivation with HHV-6 and organ involvement of the liver were frequently recorded complications. In essence, viral reactivation, severe internal organ involvement, and hematological abnormalities all portended a poorer prognosis in those experiencing DRESS syndrome recurrence. An adequate course of treatment should be maintained until clinical and laboratory parameters normalize, with a slow taper to minimize the likelihood of relapse in those most at risk.
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53
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Naveed S, Urrutia V, Kaur L, Marshall J, Malik S. Systemic Adverse Reactions to Psychotropic Medications: What Do We Need to Know? Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210803-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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54
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Su HJ, Chen CB, Yeh TY, Chung WH. Successful treatment of corticosteroid-dependent drug reaction with eosinophilia and systemic symptoms with cyclosporine. Ann Allergy Asthma Immunol 2021; 127:674-681. [PMID: 34400311 DOI: 10.1016/j.anai.2021.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) is an intractable drug hypersensitivity disease with high mortality. The current standard treatment requires high-dose and long-term systemic corticosteroids, which may lead to adverse effects and intolerability of patients. OBJECTIVE To evaluate the efficacy and safety of cyclosporine in patients with corticosteroid-dependent DRESS or intolerance to systemic corticosteroids. METHODS A retrospective review of 8 patients with corticosteroid-dependent DRESS who were treated with cyclosporine as an alternative treatment owing to suboptimal response to regular doses of systemic corticosteroids for at least 3 weeks, flare-ups when tapering corticosteroids, or experiencing intolerable adverse effects of corticosteroids. RESULTS In all 8 patients (4 women and 4 men; age range, 15-75 years), either intractable skin eruptions, persistent eosinophilia, or elevated liver function was noted after at least 3 weeks of treatment with systemic corticosteroids. The patients had marked cutaneous improvement and normalization of liver function and eosinophil count after adding cyclosporine, and the systemic corticosteroid treatment was smoothly tapered down. The mean dosage of cyclosporine was 1.68 ± 0.73 mg/kg/d, and the mean duration of cyclosporine treatment was 76.13 ± 35.64 days. Their serum eosinophil counts, serum alanine aminotransferase levels, and serum thymus and activation-regulated chemokine levels were all elevated at baseline and then significantly decreased during the recovery stage after cyclosporine therapy (P < .05). No adverse events were reported after adding cyclosporine. CONCLUSION Cyclosporine is an effective and safe therapeutic alternative as a steroid-sparing agent for corticosteroid-dependent DRESS. Further prospective randomized controlled studies are required to confirm these preliminary results.
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Affiliation(s)
- Hsing-Jou Su
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung, Taiwan; College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Fujian, People's Republic of China; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ting-Yu Yeh
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung, Taiwan; College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Fujian, People's Republic of China; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China; Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China; Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan.
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55
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Nakkam N, Konyoung P, Amornpinyo W, Saksit N, Tiamkao S, Khunarkornsiri U, Khaeso K, Pattanacheewapull O, Jorns TP, Chumworathayi P, Tassaneeyakul W. Genetic variants associated with severe cutaneous adverse drug reactions induced by carbamazepine. Br J Clin Pharmacol 2021; 88:773-786. [PMID: 34350628 DOI: 10.1111/bcp.15022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS Carbamazepine (CBZ) is one of the most common causative drugs of severe cutaneous adverse drug reactions (SCARs) including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reactions with eosinophilia and systemic symptoms. Although genetic polymorphisms of the human leucocyte antigens (HLA) are well recognized key elements for the susceptibility to CBZ-induced SCARs, some evidence suggest that polymorphisms of microsomal epoxide hydrolase 1 (EPHX1) may also contribute to the risk of these SCARs. This study investigated the association between the HLA and EPHX1 polymorphisms on CBZ-induced SCARs in large sample sizes and well-defined SCARs patients. METHODS Ninety-one CBZ-induced SCARs Thai patients and 144 CBZ-tolerant patients were enrolled in the study. The genotypes of HLA-A, HLA-B and EPHX1 were determined. RESULTS Only 2 HLA alleles including HLA-B*15:02 and HLA-A*24:07 were statistically significant association with CBZ-induced SJS/TEN. The highest risk was observed in patients with HLA-B*15:02 allele (OR = 44.33, 95% confidence interval = 20.24-97.09, corrected P-value = 6.80 × 10-29 ). Moreover, HLA-B75 serotypes were significantly associated with CBZ-induced SJS/TEN groups with an odds ratio of 81.00 (95% confidence interval = 32.39-202.56, corrected P-value = 3.84 × 10-34 ). There is no association between EPHX1 c.337 T > C polymorphism and all phenotypes of CBZ-induced SCARs. CONCLUSION The HLA-B*15:02 allele is the strongest genetic marker for the prediction of SJS/TEN induced by CBZ in Thai population. Screening for other alleles in the HLA-B75 serotype increases sensitivity for prediction of a life-threatening SCARs caused by CBZ.
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Affiliation(s)
- Nontaya Nakkam
- Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Warayuwadee Amornpinyo
- Division of Dermatology, Department of Internal Medicine, Khon Kaen Hospital, Khon Kaen, Thailand
| | - Niwat Saksit
- Unit of Excellence on Pharmacogenomic Pharmacokinetic and Pharmacotherapeutic Researches (UPPER), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Somsak Tiamkao
- Integrated Epilepsy Research Group; Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Kanyarat Khaeso
- Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Teekayu Plangkoon Jorns
- Orofacial Pain Unit, Department of Oral Biomedical Sciences, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Pansu Chumworathayi
- Pharmacy Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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56
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Bedouelle E, Ben Said B, Tetart F, Milpied B, Welfringer-Morin A, Maruani A, Catteau B, Dezoteux F, Staumont-Sallé D, Mazereeuw-Hautier J, Abasq C, Chiaverini C, Delaunay J, Mallet S, Sterling B, Puzenat E, Raynal M, Collet E, Bernier C. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Series of 49 French Pediatric Cases. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:267-274.e5. [PMID: 34332174 DOI: 10.1016/j.jaip.2021.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal adverse reaction. It can be difficult to diagnose, even more so among children, because symptoms may mimic other commonly encountered pediatric conditions. OBJECTIVE To describe clinical and laboratory features of DRESS syndrome in the pediatric population (age ≤18 years) and establish causative agents and treatment modalities. METHODS This was a multicenter retrospective study of probable and definite DRESS cases (Registry of Sever Cutaneous Adverse Reaction score ≥ 4) in children hospitalized in 15 French university hospitals between 2000 and 2020. RESULTS We included 49 cases. All children had fever and rash, 69.4% had lymphadenopathy, and 65.3% had facial edema. The most common organ affected was the liver (83.7%). Treatment consisted of topical corticosteroid in only 30.6% and systemic corticosteroid in 55.1%; 12.2% received intravenous immunoglobulin. Among probable and likely culprit drugs, 65% were antibiotics and 27.5% were antiepileptics, median time to DRESS symptom onset after initiation of 15 days (13 days with antibiotics and 21 days with antiepileptics). Twenty-seven children had allergy assessment for causative agents, 65.4% of whom had positive tests. CONCLUSIONS Culprit drugs are frequently antibiotics and antiepileptic drugs, and onset is often less than 2 weeks after treatment starts, especially with antibiotics. Treatment with topical corticosteroids appears to be sufficient in the least severe cases. Treatment by systemic corticosteroid therapy remains the reference treatment in case of severe organ damage.
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Affiliation(s)
- Eve Bedouelle
- Service de Dermatologie, Hôtel Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France.
| | - Benoit Ben Said
- Service de Dermatologie, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Florence Tetart
- Service de Dermatologie, Centre Hospitalier Universitaire de Rouen, Rouen, France; Centre Erik Satie, Unité d'Allergologie, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Brigitte Milpied
- Service de Dermatologie et Dermatologie Pédiatrique, Hôpital Saint-André et Pellegrin, Bordeaux, France
| | - Anne Welfringer-Morin
- Service de Dermatologie, Centre de Référence des Génodermatoses et des Maladies Rares à Expression Cutanée, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants Malades Université de Paris, Paris, France
| | - Annabel Maruani
- Université de Tours, INSERM 1246-SPHERE, Service de Dermatologie, Unité de Dermatologie Pédiatrique, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Benoit Catteau
- Service de Dermatologie Center Hospitalier Universitaire de Lille, Université de Lille, Institute for Translational Research in Inflammation, INSERM, Lille, France
| | - Frédéric Dezoteux
- Service de Dermatologie Center Hospitalier Universitaire de Lille, Université de Lille, Institute for Translational Research in Inflammation, INSERM, Lille, France
| | - Delphine Staumont-Sallé
- Service de Dermatologie Center Hospitalier Universitaire de Lille, Université de Lille, Institute for Translational Research in Inflammation, INSERM, Lille, France
| | | | - Claire Abasq
- Service de Dermatologie, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | | | - Juliette Delaunay
- Service de Dermatologie, Centre Hospitalier Universitaire d'Angers site Larrey, Angers, France
| | - Stéphanie Mallet
- Service de Dermatologie et Cancérologie Cutanée, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Benoit Sterling
- Services de Pédiatrie et Pneumologie Pédiatrique, Hôpital de La Timone-Enfants et Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Eve Puzenat
- Service de Dermatologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Margot Raynal
- Service de Dermatologie, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Evelyne Collet
- Service de Dermatologie, Hôpital Le Bocagen, Centre Hospitalier Régional Universitaire de Dijon, Dijon, France
| | - Claire Bernier
- Service de Dermatologie, Hôtel Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France.
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57
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Zhang J, Lei Z, Xu C, Zhao J, Kang X. Current Perspectives on Severe Drug Eruption. Clin Rev Allergy Immunol 2021; 61:282-298. [PMID: 34273058 PMCID: PMC8286049 DOI: 10.1007/s12016-021-08859-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/16/2022]
Abstract
Adverse drug reactions involving the skin are commonly known as drug eruptions. Severe drug eruption may cause severe cutaneous adverse drug reactions (SCARs), which are considered to be fatal and life-threatening, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). Although cases are relatively rare, approximately 2% of hospitalized patients are affected by SCARs. There is an incidence of 2 to 7 cases/million per year of SJS/TEN and 1/1000 to 1/10,000 exposures to offending agents result in DRESS. However, the mortality rate of severe drug eruptions can reach up to 50%. SCARs represent a real medical emergency, and early identification and proper management are critical to survival. The common pathogenesis of severe drug eruptions includes genetic linkage with HLA- and non-HLA-genes, drug-specific T cell-mediated cytotoxicity, T cell receptor restriction, and cytotoxicity mechanisms. A multidisciplinary approach is required for acute management. Immediate withdrawal of potentially causative drugs and specific supportive treatment is of great importance. Immunoglobulins, systemic corticosteroids, and cyclosporine A are the most frequently used treatments for SCARs; additionally, new biologics and plasma exchange are reasonable strategies to reduce mortality. Although there are many treatment methods for severe drug eruption, controversies remain regarding the timing and dosage of drug eruption. Types, dosages, and indications of new biological agents, such as tumor necrosis factor antagonists, mepolizumab, and omalizumab, are still under exploration. This review summarizes the clinical characteristics, risk factors, pathogenesis, and treatment strategies of severe drug eruption to guide clinical management.
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Affiliation(s)
- Jingzhan Zhang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Tianshan District, No. 91, Tianchi Road, Urumqi, 830001, Xinjiang, China.,Xinjiang Key Laboratory of Dermatology Research, Urumqi, Xinjiang, China
| | - Zixian Lei
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Tianshan District, No. 91, Tianchi Road, Urumqi, 830001, Xinjiang, China.,Xinjiang Key Laboratory of Dermatology Research, Urumqi, Xinjiang, China
| | - Chen Xu
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Tianshan District, No. 91, Tianchi Road, Urumqi, 830001, Xinjiang, China.,Xinjiang Key Laboratory of Dermatology Research, Urumqi, Xinjiang, China
| | - Juan Zhao
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Tianshan District, No. 91, Tianchi Road, Urumqi, 830001, Xinjiang, China.,Xinjiang Key Laboratory of Dermatology Research, Urumqi, Xinjiang, China
| | - Xiaojing Kang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Tianshan District, No. 91, Tianchi Road, Urumqi, 830001, Xinjiang, China. .,Xinjiang Key Laboratory of Dermatology Research, Urumqi, Xinjiang, China.
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58
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Truong K, Kelly S, Bayly A, Smith A. Successful mepolizumab treatment for DRESS-induced refractory eosinophilic myocarditis and concurrent thyroiditis. BMJ Case Rep 2021; 14:14/7/e242240. [PMID: 34266818 DOI: 10.1136/bcr-2021-242240] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening adverse drug reaction with a mortality rate of 10%. Interstitial nephritis, pneumonitis, myocarditis, meningitis, thyroiditis and pancreatitis are major causes of morbidity and mortality in this syndrome. Cessation of offending medication is paramount. There is paucity in high quality prospective studies guiding the treatment of DRESS, and there are no published therapeutic clinical trials in the treatment of corticosteroid refractory hypersensitivity myocarditis. The authors present a unique case of ciprofloxacin-induced DRESS with concurrent thyroiditis and refractory eosinophilic myocarditis that required mepolizumab and multiple immunosuppressants for successful treatment.
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Affiliation(s)
- Kelvin Truong
- Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia .,Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Shane Kelly
- Department of Clinical Immunology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Angela Bayly
- Department of Tissue Pathology and Diagnostic Oncology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Annika Smith
- Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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59
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Janus kinase inhibitors in dermatology: Part I. A comprehensive review. J Am Acad Dermatol 2021; 86:406-413. [PMID: 34246698 DOI: 10.1016/j.jaad.2021.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 01/12/2023]
Abstract
The Janus kinase-signal transducer and activator of transcription (JAK-STAT) intracellular signaling pathway is utilized by many proinflammatory molecules to mediate downstream effects and activate gene transcription. Activation of the JAK-STAT pathway contributes to a number of inflammatory dermatoses. Clinical trials and smaller studies have demonstrated the efficacy of JAK inhibitors in the treatment of a variety of dermatologic conditions. Here, we review the use of JAK inhibitors for the treatment of a wide range of dermatologic diseases in a two-part review series.
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60
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Owen CE, Jones JM. Recognition and Management of Severe Cutaneous Adverse Drug Reactions (Including Drug Reaction with Eosinophilia and Systemic Symptoms, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis). Med Clin North Am 2021; 105:577-597. [PMID: 34059239 DOI: 10.1016/j.mcna.2021.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Severe cutaneous adverse reactions to medications (SCARs) include drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. They are all non-immunoglobulin E mediated hypersensitivity reaction patterns, distinguished from simple cutaneous drug eruptions by immunologic pathogenesis and internal organ involvement. Herein the clinical features, diagnostic workup, and management considerations are presented for each of these major SCARs.
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Affiliation(s)
- Cindy England Owen
- Division of Dermatology, Department of Medicine, 3810 Springhurst Boulevard, Suite 200, Louisville, KY 40241, USA.
| | - Jordan M Jones
- Division of Dermatology, Department of Medicine, 3810 Springhurst Boulevard, Suite 200, Louisville, KY 40241, USA
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61
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Portney DA, Baker HP, Boyle MM, Barbosa VH, Luu HH. Drug Reaction with Eosinophilia and Systemic Syndrome in Revision Arthroplasty for a Prosthetic Knee Infection: A Case Report. JBJS Case Connect 2021; 11:e20.00805. [PMID: 34038391 DOI: 10.2106/jbjs.cc.20.00805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 51-year-old woman underwent stage I of a 2-stage revision for a prosthetic knee infection with a vancomycin-impregnated articulating cement spacer followed by IV vancomycin and ceftriaxone. Four weeks later, she developed fevers, a diffuse cutaneous eruption, lymphadenopathy, transaminitis, and acute renal tubular necrosis before being diagnosed with drug reaction with eosinophilia and systemic syndrome (DRESS). CONCLUSION DRESS is a rare, potentially life-threatening adverse drug reaction with cutaneous manifestations and multiorgan involvement. Although rare, its incidence in orthopaedic patients is likely to increase with the aging population. It must be recognized early to minimize end-stage organ dysfunction and mortality.
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Affiliation(s)
- Daniel A Portney
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
| | - Hayden P Baker
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
| | - Margaret M Boyle
- Department of Dermatology, University of Chicago, Chicago, Illinois
| | | | - Hue H Luu
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
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62
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Delgado MG, Casu S, Montani M, Brunner F, Semmo N, Berzigotti AB, Dufour JF. Hepatic manifestations of drug reaction with eosinophilia and systemic symptoms syndrome. EXPLORATION OF MEDICINE 2021. [DOI: 10.37349/emed.2021.00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening drug reaction, which can affect multiple organs. Patients with DRESS syndrome and hepatic manifestations may present alterations ranging from mild hepatitis to acute liver failure. The diagnosis might be difficult, and the management of these patients is challenging. This report analyzes a series of five cases reporting the clinical presentation, which ranged from acute hepatitis to liver failure, and discussed their treatment.
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Affiliation(s)
- Maria Gabriela Delgado
- Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
| | - Stefania Casu
- ASST Santi Paolo e Carlo, Hepatology and Gastroenterology Unit, 20153 Milano, Italy
| | - Matteo Montani
- Institute of Pathology, Inselspital, University Hospital Bern, 3008 Bern, Switzerland
| | - Felix Brunner
- Clinic of Gastroenterolgy and Hepatology, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
| | - Nasser Semmo
- Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
| | - Annalisa Berzigotti Berzigotti
- Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, 3010 Bern, Switzerland 5Hepatology, Department of Biomedical Research, University of Bern, 3008 Bern, Switzerland
| | - Jean François Dufour
- Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, 3010 Bern, Switzerland 5Hepatology, Department of Biomedical Research, University of Bern, 3008 Bern, Switzerland
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63
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Porur A, Bandyopadhyay A, Jain K. Phenytoin, seizure prophylaxis and DRESS: Time to reappraisal. Anaesth Crit Care Pain Med 2021; 40:100861. [PMID: 33866046 DOI: 10.1016/j.accpm.2021.100861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ajith Porur
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Anjishnujit Bandyopadhyay
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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64
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Mata L, Torres-Zevallos H, Guerreros AG. Life-threatening DRESS syndrome with kidney damage following severe COVID-19 in a patient with Down syndrome. BMJ Case Rep 2021; 14:14/4/e241418. [PMID: 33875507 PMCID: PMC8057573 DOI: 10.1136/bcr-2020-241418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lorena Mata
- Department of Research and Education, Clinica Internacional SA, Lima, Peru
| | - Hernando Torres-Zevallos
- Department of Research and Education, Clinica Internacional SA, Lima, Peru.,Department of Pulmonology, Clinica Internacional SA, Lima, Peru
| | - Alfredo Gilberto Guerreros
- Department of Research and Education, Clinica Internacional SA, Lima, Peru .,Department of Pulmonology, Clinica Internacional SA, Lima, Peru
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65
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Shah P, Roman J, Meehan S, Femia AN. A case of drug reaction with eosinophilia and systemic symptoms with colitis as a presenting feature. JAAD Case Rep 2021; 12:22-24. [PMID: 33997220 PMCID: PMC8105175 DOI: 10.1016/j.jdcr.2021.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Payal Shah
- Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Jorge Roman
- Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Shane Meehan
- Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
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66
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Rao S, Sunkara A, Srivastava N, Sampat P, Ramos C, Albert E. An Uncommon Presentation of DRESS Syndrome Secondary to Leflunomide Use: A Case Report. J Investig Med High Impact Case Rep 2021; 9:2324709621997282. [PMID: 33629602 PMCID: PMC7926050 DOI: 10.1177/2324709621997282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a constellation of symptoms that manifest as a result of certain medications. Several antipsychotics, antibiotics, and sulfa-containing drugs are known to be implicated in the etiology of DRESS syndrome. The clinical presentation of this disorder consists of a diffuse rash, lymphadenopathy, and systemic organ damage. Our patient presented with symptoms consistent with DRESS syndrome after being started on leflunomide, which is not commonly associated with DRESS. The diagnostic workup comprised of monitoring inflammatory markers on laboratory work, an excisional lymph node biopsy (to rule out malignancy), and a skin biopsy (to assess the etiology of the rash). Our patient received systemic steroids, dose-adjusted based on expert opinion. Further research is required to explore the association between leflunomide and DRESS and address guidelines for the management of DRESS.
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Affiliation(s)
- Suman Rao
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | | | - Parth Sampat
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Emily Albert
- SUNY Upstate Medical University, Syracuse, NY, USA
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67
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Salah NB, Soua Y, Trimeche K, Lahouel I, Fathel NB, Korbi M, Belhadjali H, Youssef M, Zili J. Atypical presentation of lamotrigine-induced drug reaction with eosinophilia and systemic symptoms. Dermatol Ther 2021; 34:e14875. [PMID: 33583112 DOI: 10.1111/dth.14875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/03/2020] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nesrine Ben Salah
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Yosra Soua
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Khaoula Trimeche
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Ines Lahouel
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Najah Ben Fathel
- Department of Pharmacology, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Mouna Korbi
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Hichem Belhadjali
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Monia Youssef
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Jameledin Zili
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
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68
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Scrace B, Fityan A, Bigham C. Drug reactions with eosinophilia and systemic symptoms. BJA Educ 2021; 20:65-71. [PMID: 33456932 DOI: 10.1016/j.bjae.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- B Scrace
- Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - A Fityan
- Southampton University Hospitals NHS Trust, Southampton, UK
| | - C Bigham
- Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
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69
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Ali SB, Schweikert S, Brusch A. Drug reaction with eosinophilia and systemic symptoms syndrome secondary to acetazolamide associated with markedly elevated procalcitonin. BMJ Case Rep 2021; 14:14/1/e236966. [PMID: 33462002 PMCID: PMC7813420 DOI: 10.1136/bcr-2020-236966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an important cause of multi-organ dysfunction and can mimic other disorders including sepsis. We describe a patient presenting with septic shock and accompanying high procalcitonin. Although initially treated empirically with antibiotics, the emergence of eosinophilia during the admission lead to a revised diagnosis of DRESS syndrome, presumed secondary to acetazolamide. This case highlights the importance of regular clinical assessment and re-evaluation is key in identifying emerging features such as eosinophilia, rash and organ dysfunction, which can secure the diagnosis. Furthermore, the case also highlights that acetazolamide may be a rare cause of DRESS syndrome.
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Affiliation(s)
- Syed Basharat Ali
- Department of Immunology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sacha Schweikert
- Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anna Brusch
- Department of Immunology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Abstract
PURPOSE OF REVIEW To provide updates on recent advances in the diagnosis and management of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. RECENT FINDINGS The number of identified HLA allele associations with DRESS continues to grow. There is increasing evidence indicating viral infection, reactivation, and cross-reactivity may play key roles in disease. Translational work illuminated JAK/STAT activation in recalcitrant disease. There is expanding recognition of rapid-onset DRESS resulting from specific drugs. SUMMARY DRESS is a severe form of adverse drug reaction with potential for significant morbidity and mortality. Recent research advances may improve clinical care. HLA screening can now be performed to prevent disease in susceptible patients and may help identify culprit drugs in the near future. Viral testing should be performed on every patient, and if positive, patients potentially treated with antiviral therapy. JAK inhibitors may be an effective treatment option for DRESS. Early onset of disease relative to drug exposure should not exclude the diagnosis of DRESS.
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71
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Pye B, Aguilar JM, Maranich AM. A 15-year-old Boy Presents with Fever and Pruritic Rash for 6 Days. Pediatr Rev 2021; 42:S63-S66. [PMID: 33386365 DOI: 10.1542/pir.2019-0339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Brandon Pye
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI
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72
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Nicholas R, Bindra MS, Mathew L, Sathishkumar D, Lakshmanan J, George R. The Role of Frozen Section in the Rapid Diagnosis of Severe Cutaneous Adverse Drug Reactions. Indian Dermatol Online J 2021; 12:78-83. [PMID: 33768026 PMCID: PMC7982049 DOI: 10.4103/idoj.idoj_397_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/07/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Early diagnosis is the mainstay in the management of severe cutaneous adverse reactions (SCARs) to drugs. AIMS To study the role of frozen section in the rapid diagnosis of SCARs and the impact on outcome of the affected patients. SETTINGS AND DESIGN A single-blind, hospital-based study was conducted from December 2014-July 2016. METHODS AND MATERIAL We biopsied 32 adults with SCARs diagnosed by clinical features and standard criteria. The histopathological features seen on frozen sections were compared to that of paraffin blocks. The impact of rapid diagnosis on the clinical outcome was studied in toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). STATISTICAL ANALYSIS Z test was used to compare two proportions. Kappa statistic, sensitivity, specificity, positive predictive value, and negative predictive value of the frozen section diagnosis were calculated in TEN/SJS and DRESS using MedCalc software. RESULTS Frozen and paraffin sections were done in TEN/SJS spectrum (13), DRESS (17), and AGEP (2). The sensitivity, specificity and kappa values for frozen section diagnosis in SJS/TEN and DRESS were 91.7%, 95%, 0.867 and 94.4%, 100%, 0.937 respectively. The concordance between frozen and paraffin section diagnosis was 100% in TEN, SJS, DRESS and AGEP. All the 6 patients with TEN and 2 with AGEP survived. Taking the worst-case scenario, the mortality in SJS was 28.6%. The mortality among patients with DRESS was 11.8%. CONCLUSIONS Frozen section helps in the rapid diagnosis and early treatment of SCARs and differentiates it from diseases that mimic it.
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Affiliation(s)
- Rajam Nicholas
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mandeep Singh Bindra
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lydia Mathew
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dharshini Sathishkumar
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Renu George
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
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73
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Farooq S, Narala S, Pacha O. Alectinib-associated drug reaction with eosinophilia and systemic symptoms syndrome. JAAD Case Rep 2020; 6:1339-1341. [PMID: 33304973 PMCID: PMC7708757 DOI: 10.1016/j.jdcr.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sahira Farooq
- McGovern Medical School, University of Texas Health Science Center at Houston, Texas
- Correspondence to: Sahira Farooq, BS, 6431 Fannin St, MSB G.400, Houston, TX 77030.
| | - Saisindhu Narala
- Department of Dermatology, University of Texas Health Science Center at Houston, Texas
| | - Omar Pacha
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
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74
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Kherlopian A, Fischer G, Fong G. Drug reaction with eosinophilia and systemic symptoms due to agomelatine. Australas J Dermatol 2020; 62:e336-e337. [PMID: 33216948 DOI: 10.1111/ajd.13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ashod Kherlopian
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Gayle Fischer
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Gloria Fong
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
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75
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Drug reaction with eosinophilia and systemic symptoms (DRESS) with severe and atypical lung involvement. Radiol Case Rep 2020; 15:2178-2182. [PMID: 32944113 PMCID: PMC7481882 DOI: 10.1016/j.radcr.2020.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms is a rare and potentially fatal drug hypersensitivity reaction. Reactions include skin eruption, fever, hematologic abnormalities (eosinophilia or atypical lymphocytosis), enlarged lymph nodes, and/or organic involvement. The liver is the most commonly compromised organ. We present a case of drug reaction with eosinophilia and systemic symptoms associated with Naproxen intake in a young female patient with severe lung involvement. The patient's chest tomography highlights the presence of adenomegalies, pericardial and pleural effusion, peribroncovascular consolidations, and centrilobular nodules. After reviewing the literature few similar cases were found. The main radiological alterations in those cases included interstitial opacities attributed to pneumonitis. Therefore, this case study is considered an unusual case with atypical presentation of drug-induced eosinophilic lung disease.
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76
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Singh P, Schwartz RA. Disseminated intravascular coagulation: A devastating systemic disorder of special concern with COVID-19. Dermatol Ther 2020; 33:e14053. [PMID: 32700813 PMCID: PMC7404500 DOI: 10.1111/dth.14053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
Disseminated intravascular coagulation (DIC) is linked with severe COVID-19, prompting considerable concern. DIC can be a devastating systemic disorder. It is often markedly manifest on the skin as acrocyanosis or as petechiae and purpura with progression to hemorrhagic bullae. Subcutaneous hematomas may occur, as may thrombotic findings including necrosis and gangrene. The most common cause is infection, with special emphasis now on COVID-19. We have reviewed the medical literature under the search terms "Disseminated intravascular coagulation" and "consumption coagulopathy" for the past two decades in the English language using Medline and Google Scholar to update special concerns and considerations, focusing on those with COVID-19. Skin findings with DIC may be prominent. The severity of cutaneous lesions often correlates with the gravity of systemic disease. DIC is most effectively treated by addressing the underlying cause and resuscitating the patient using supportive measures. It is pivotal to recognize and treat DIC early, before deadly complications, such as multiple organ failure, arise.
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Affiliation(s)
- Parmvir Singh
- DermatologyRutgers‐New Jersey Medical SchoolNewarkNew JerseyUSA
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77
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Torres‐Navarro I, de Unamuno‐Bustos B, Botella‐Estrada R. Systematic review of BRAF/MEK inhibitors‐induced Severe Cutaneous Adverse Reactions (SCARs). J Eur Acad Dermatol Venereol 2020; 35:607-614. [DOI: 10.1111/jdv.16894] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
Affiliation(s)
- I. Torres‐Navarro
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
| | - B. de Unamuno‐Bustos
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
| | - R. Botella‐Estrada
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
- Department of Medicine Universitat de València València Spain
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78
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Management of Immune-Related Cutaneous Adverse Reactions to PD-1 and PD-L1 Inhibitors for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00314-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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79
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Tan CM, Zipursky JS. Acute generalized exanthematous pustulosis caused by an intravenous radiocontrast medium. CMAJ 2020; 192:E1097. [PMID: 32958574 DOI: 10.1503/cmaj.200364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Carolyn Michelle Tan
- Department of Medicine (Tan, Zipursky), Sunnybrook Health Sciences Centre; Department of Medicine (Tan, Zipursky); Division of Clinical Pharmacology and Toxicology (Zipursky); Institute of Health Policy, Management, and Evaluation (Zipursky), University of Toronto, Toronto, Ont.
| | - Jonathan Samuel Zipursky
- Department of Medicine (Tan, Zipursky), Sunnybrook Health Sciences Centre; Department of Medicine (Tan, Zipursky); Division of Clinical Pharmacology and Toxicology (Zipursky); Institute of Health Policy, Management, and Evaluation (Zipursky), University of Toronto, Toronto, Ont
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80
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Yang JJ, Lei DK, Ravi V, Maloney NJ, Crew A, Worswick S. Overlap between hemophagocytic lymphohistiocytosis and drug reaction and eosinophilia with systemic symptoms: a review. Int J Dermatol 2020; 60:925-932. [PMID: 32964443 DOI: 10.1111/ijd.15196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/21/2020] [Accepted: 08/26/2020] [Indexed: 12/17/2022]
Abstract
Drug reaction and eosinophilia with systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DIHS), shares features with hemophagocytic lymphohistiocytosis (HLH), most notably fever, rash, and internal organ involvement. However, there is increasing recognition of drug-induced (secondary) HLH and biopsy-proven hemophagocytosis in DRESS, suggesting that HLH and DRESS not only overlap but also may be diseases on the same spectrum of immune dysfunction. To characterize existing literature on HLH/DRESS overlap, we queried the PubMed/MEDLINE database for 23 cases of HLH-DRESS codiagnosis. Average time-to-onset of rash after exposure to inciting drug was 2.7 weeks. Fourteen cases (61%) clinically worsened despite initial therapy, prompting a workup with diagnosis of HLH on average 2.3 weeks after diagnosing DRESS. Nine cases met HLH diagnostic criteria and had a RegiSCAR score ≥4. Nine cases met one set of criteria with a presentation suggestive of the other. Five cases met neither criteria. A patient presenting with fever, generalized rash, bicytopenia, and internal organ involvement after drug exposure was most predictive of meeting diagnostic criteria for both HLH and DRESS. Treatment was highly variable, although most initiated systemic corticosteroids with/without IVIG, plasmapheresis, or etoposide. Patients with poor outcomes in this review were treated using steroid monotherapy and had viral reactivation. Dermatologists should consider the possibility of HLH in any patient presenting with fever, rash, internal organ involvement, and cytopenia. Additional studies will be necessary to further characterize HLH and DRESS overlap and determine optimal management.
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Affiliation(s)
- Jason J Yang
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Donald K Lei
- Department of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Vignesh Ravi
- Department of Dermatology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Nolan J Maloney
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ashley Crew
- Department of Dermatology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Scott Worswick
- Department of Dermatology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
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81
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Affiliation(s)
- Adam Cohen
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Asha Morrow
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Meghan McClure
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
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82
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Chang WC, Hung SI, Carleton BC, Chung WH. An update on CYP2C9 polymorphisms and phenytoin metabolism: implications for adverse effects. Expert Opin Drug Metab Toxicol 2020; 16:723-734. [DOI: 10.1080/17425255.2020.1780209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Wan-Chun Chang
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shuen-Iu Hung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Linkou, Taiwan
- Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Pharmaceutical Outcomes Programme, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Linkou, Taiwan
- Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Dermatology, Xiamen Chang Gung Hospital, Teaching Hospital of School of Medicine, Tsinghua University, China
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83
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Zargham H, Ghazal S, Watters K, Nguyen KH. A case of toxic epidermal necrosis-like cutaneous eruption as the first manifestation and clue to the diagnosis of systemic lupus erythematosus: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20940420. [PMID: 32728443 PMCID: PMC7364792 DOI: 10.1177/2050313x20940420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 11/20/2022] Open
Abstract
We present a rare case of a 61-year-old woman presenting with a widespread erosive eruption on her torso and extremities. Although the lesions were histologically compatible with toxic epidermal necrolysis, clinically the patient was hemodynamically stable, had no mucosal involvement and had no relevant medical history or potentially incriminating medications. Further investigations uncovered a new diagnosis of systemic lupus erythematosus, with this toxic epidermal necrolysis-like eruption being the first presentation of the disease. This case highlights the importance of broadening the differential diagnosis in patients presenting with acute widespread cleavage of the epidermis, using the spectrum of acute syndrome of apoptotic pan-epidermolysis as a reference.
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Affiliation(s)
- Hanieh Zargham
- Division of Dermatology, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | | | - Kevin Watters
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Khue Huu Nguyen
- Division of Dermatology, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
- Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
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84
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Abstract
Drug eruptions in children are common but in general less studied than their adult counterparts. Aside from having significant impact on the child's health and quality of life, these reactions can limit what medications the patient can receive in the future. Familiarity with pediatric drug eruptions is important for accurate diagnosis and to prevent future recurrence or ineffective therapy. Our current understanding of how drug reactions differ mechanistically between children and adults is poor. There are multiple factors that could be contributing to the differing incidence, presentation, and treatment modalities offered to pediatric versus adult patients. For many of these cutaneous drug reactions, the treatment regime is not standardized, being based primarily on case reports. Although not comprehensive, this review highlights common pediatric drug eruption patterns and discuss diagnostic mimickers. Five cutaneous adverse drug reactions in the pediatric population are presented: morbilliform (exanthematous) eruptions, urticarial eruptions, serum sickness-like reactions, fixed drug eruptions, and DRESS syndrome. Clinical features, diagnostic workup, and management are discussed with an emphasis on the pediatric population.
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Affiliation(s)
- EmilyD Nguyen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Colleen K Gabel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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85
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Abstract
Drug reactions resulting from chemotherapy agents are common and frequently affect the skin. Although often benign, a select few of these cutaneous reactions may necessitate immediate changes to the antineoplastic regimens. Given the diversity of chemotherapeutic skin reactions and their complex implications on patient management, an organized conceptual schema is imperative for proper patient care. We evaluate a number of commonly seen chemotherapy-induced skin toxicities organized by pathogenic mechanism and drug class, providing a framework for the identification and categorization of adverse events to prevent unrecognition. Groupings of these reactions include direct cytotoxicity and/or drug accumulation, immunologic hypersensitivity, and aberrant molecular signaling.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA.
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86
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Lameiras C, Ornelas É, Mendes Lopes M, Dória MDC. Republished: Drug reaction with eosinophilia and systemic symptoms syndrome in a patient taking lamotrigine. Drug Ther Bull 2020; 58:93-95. [PMID: 32234726 DOI: 10.1136/dtb.2019.229180rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Énia Ornelas
- Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
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87
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Novo de Matos J, Redondo Sendino A, Pozo Teruel A, Redondo Sendino JI. [DRESS syndrome simulating coronavirus 2019-NcoV disease]. Semergen 2020; 47:56-58. [PMID: 32507709 PMCID: PMC7241394 DOI: 10.1016/j.semerg.2020.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/18/2022]
Affiliation(s)
- J Novo de Matos
- Medicina de Familia, Centro de Salud Canillejas, Madrid, España
| | | | - A Pozo Teruel
- Medicina de Familia, Centro de Salud Canillejas, Madrid, España
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88
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Hornick N, Wang A, Lim Y, Gehlhausen J, Siegel J, Wang J, Foss F, Lim I, Zubek A, Milstone L, Galan A, King B, Damsky W. Development or worsening of sarcoidosis associated with IL-17 blockade for psoriasis. J Eur Acad Dermatol Venereol 2020; 34:e583-e585. [PMID: 32277505 DOI: 10.1111/jdv.16451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- N Hornick
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - A Wang
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Y Lim
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - J Gehlhausen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - J Siegel
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - J Wang
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - F Foss
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - I Lim
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - A Zubek
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - L Milstone
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - A Galan
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - B King
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - W Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
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89
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Álvarez-García L, López Amor L, Escudero Augusto D. Liver transplantation in a patient with fulminant hepatitis by DRESS syndrome. Med Clin (Barc) 2020; 156:363-364. [PMID: 32359963 DOI: 10.1016/j.medcli.2020.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/24/2019] [Accepted: 01/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Álvarez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de Investigación Microbiología Traslacional, Instituto Sanitario de Investigación Principado de Asturias (ISPA), Oviedo, Asturias, España.
| | - Lucia López Amor
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de Investigación Microbiología Traslacional, Instituto Sanitario de Investigación Principado de Asturias (ISPA), Oviedo, Asturias, España
| | - Dolores Escudero Augusto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de Investigación Microbiología Traslacional, Instituto Sanitario de Investigación Principado de Asturias (ISPA), Oviedo, Asturias, España
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90
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Waldman RA, Grant-Kels JM. Thinking outside the box: Is there a role for extracorporeal blood purification in DRESS syndrome complicated by acute kidney injury? Clin Dermatol 2020; 38:580-583. [PMID: 33280807 DOI: 10.1016/j.clindermatol.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Drug reaction with eosinophilia and systemic clinical manifestations (DRESS syndrome) is a potentially fatal drug reaction that is hallmarked by a hypercytokinemic state that results in organ dysfunction. For this reason, plasmapheresis and therapeutic plasma exchange are being increasingly utilized in DRESS syndrome refractory to systemic corticosteroids to remove the pathogenic cytokines that cause end-organ damage. This contribution proposes a novel approach to DRESS syndrome complicated by acute kidney injury. Specifically, the authors argue that patients with DRESS syndrome complicated by acute kidney injury may benefit from utilization of specific forms of renal replacement therapy that also provide plasmapheresis. This is relevant acute kidney injury that develops in more than one-third of cases of DRESS syndrome with at least 10% of cases progressing to acute renal failure requiring renal replacement therapy. Renal replacement therapy can include intermittent hemodialysis or continuous renal replacement therapy.
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Affiliation(s)
- Reid A Waldman
- Department of Dermatology, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut, School of Medicine, Farmington, Connecticut, USA.
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91
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Schwartz RA, Janniger CK. Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine. Dermatol Ther 2020; 33:e13380. [PMID: 32253799 PMCID: PMC7235477 DOI: 10.1111/dth.13380] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/19/2022]
Abstract
A severe cutaneous drug reaction resembling acute generalized exanthematous pustulosis resulting from ingestion of hydroxychloroquine has been documented. It is distinguishable by its longer incubation period, more varied morphology with initially urticarial and later targetoid and arcuate plaques, recalcitrance to therapy and longer duration. Given the anticipated surge in the use of hydroxychloroquine due to its reported benefits in those with coronavirus disease 2019, specific recognition of this entity is pivotal. We delineate it as generalized pustular figurate erythema.
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92
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Parsi M, Daniel C. Lamotrigine-induced DRESS Syndrome Manifesting as 'Eosinophilic Colitis': An Uncommon Presentation of a Very Uncommon Condition. Cureus 2020; 12:e7570. [PMID: 32391219 PMCID: PMC7205376 DOI: 10.7759/cureus.7570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare drug-induced hypersensitivity reaction that manifests with a variety of signs and symptoms. It is an important condition that must be recognized by all physicians because if untreated, it can be fatal. There are a variety of medications that are responsible for this condition. The liver, lungs, and kidneys are commonly affected, with the involvement of the gastrointestinal tract being very rare; only a few cases are reported worldwide. We are presenting a case of lamotrigine-induced DRESS syndrome manifesting as colitis. A 32-year-old female presented with diarrhea, two weeks after the initiation of lamotrigine. Her condition worsened with the development of a generalized rash and bloody diarrhea. Further investigations revealed that she likely had a drug reaction secondary to lamotrigine. Fortunately, prompt initiation of systemic steroids led to the resolution of her symptoms.
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Affiliation(s)
- Meghana Parsi
- Internal Medicine, Crozer-Chester Medical Center, Upland, USA
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93
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Abstract
Allopurinol, a first line urate-lowering therapy, has been associated with serious cutaneous reactions that have a high mortality. A number of risk factors for these serious adverse reactions have been identified including ethnicity, HLA-B∗5801 genotype, kidney impairment, allopurinol starting dose, and concomitant diuretic use. There is a complex interplay between these risk factors, which may (albeit rarely) lead to allopurinol-related serious adverse events. Although oxypurinol, the active metabolite of allopurinol, has been implicated, there is no defined drug concentration at which the reaction will occur. There is no specific treatment other than the cessation of allopurinol and supportive care. Whether hemodialysis, which rapidly removes oxypurinol, improves outcomes remains to be determined. Strategies to help reduce this risk are therefore important, which includes screening for HLA-B∗5801 in high-risk individuals, commencing allopurinol at low dose, and educating patients about the signs and symptoms of severe cutaneous adverse reactions, and what to do if they occur.
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94
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Lin CC, Chen CB, Wang CW, Hung SI, Chung WH. Stevens-Johnson syndrome and toxic epidermal necrolysis: risk factors, causality assessment and potential prevention strategies. Expert Rev Clin Immunol 2020; 16:373-387. [DOI: 10.1080/1744666x.2020.1740591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Chu-Chi Lin
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Keelung, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Keelung, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuang-Wei Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Keelung, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shuen-Iu Hung
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Keelung, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
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95
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Chapman S, Adelman M, Sullivan A, Mancuso J, Lim HW. Apremilast-associated drug reaction with eosinophilia and systemic symptoms. JAAD Case Rep 2020; 6:302-304. [PMID: 32258304 PMCID: PMC7109365 DOI: 10.1016/j.jdcr.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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96
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Lotti T, Agarwal K, Podder I, Satolli F, Kassir M, Schwartz RA, Wollina U, Grabbe S, Navarini AA, Mueller SM, Goldust M. Safety of the current drug treatments for vitiligo. Expert Opin Drug Saf 2020; 19:499-511. [PMID: 32067513 DOI: 10.1080/14740338.2020.1729737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Vitiligo is an acquired depigmenting skin disorder adversely affecting the patient's quality of life. Despite the presence of several treatment modalities, ranging from medical to physical to surgical options, none is curative. Each modality has its own drawbacks and side effects. Thus, the treatment modality needs to be tailored for each individual patient taking into consideration the disease characteristics and also its efficacy and safety to obtain a favorable risk-benefit ratio.Areas covered: This review highlights the different treatment modalities utilized in vitiligo up until 4 November 2019 along with their adverse effects and contraindications, if any.Expert opinion: All the medications have their own adverse effects and contraindications. We have included the most commonly used topical corticosteroids, which may result in striae, cutaneous atrophy, and tachyphylaxis, to the recently introduced biologics, which may induce hypersensitivity reactions, systemic toxicities, and even malignancies. However, more long-term studies are needed to assess the safety of these medications, especially the newer ones, to provide a safe and effective treatment for this disorder.
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Affiliation(s)
- Torello Lotti
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
| | | | | | | | | | | | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander A Navarini
- Department of Dermatology & Allergy, University Hospital of Basel, Basel, Switzerland
| | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Mohamad Goldust
- Department of Dermatology, University Hospital Basel, Basel, Switzerland.,University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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97
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Dinesh Kumar J, Geminiganesan S, Padmanaban R, Pinnaka S, Chandrasekar T. An Unusual Case of Cardiomyopathy in a Child. Indian J Pediatr 2020; 87:226. [PMID: 31721073 DOI: 10.1007/s12098-019-03086-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/17/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Jayapalan Dinesh Kumar
- Department of Pediatrics, Sri Ramachandra Institute of Higher Center, Porur, Chennai, 600116, India.
| | - Sangeetha Geminiganesan
- Department of Pediatrics, Sri Ramachandra Institute of Higher Center, Porur, Chennai, 600116, India
| | - Ramachandran Padmanaban
- Department of Pediatrics, Sri Ramachandra Institute of Higher Center, Porur, Chennai, 600116, India
| | - Subbarao Pinnaka
- Department of Pediatrics, Sri Ramachandra Institute of Higher Center, Porur, Chennai, 600116, India
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98
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Kim D, Kobayashi T, Voisin B, Jo JH, Sakamoto K, Jin SP, Kelly M, Pasieka HB, Naff JL, Meyerle JH, Ikpeama ID, Fahle GA, Davis FP, Rosenzweig SD, Alejo JC, Pittaluga S, Kong HH, Freeman AF, Nagao K. Targeted therapy guided by single-cell transcriptomic analysis in drug-induced hypersensitivity syndrome: a case report. Nat Med 2020; 26:236-243. [PMID: 31959990 PMCID: PMC7105105 DOI: 10.1038/s41591-019-0733-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 12/06/2019] [Indexed: 12/17/2022]
Abstract
Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DiHS/DRESS) is a potentially fatal multiorgan inflammatory disease associated with herpesvirus reactivation and subsequent onset of autoimmune diseases1-4. Pathophysiology remains elusive and therapeutic options are limited. Cases refractory to corticosteroid therapy pose a clinical challenge1,5 and approximately 30% of patients with DiHS/DRESS develop complications, including infections and inflammatory and autoimmune diseases1,2,5. Progress in single-cell RNA sequencing (scRNA-seq) provides an opportunity to dissect human disease pathophysiology at unprecedented resolutions6, particularly in diseases lacking animal models, such as DiHS/DRESS. We performed scRNA-seq on skin and blood from a patient with refractory DiHS/DRESS, identifying the JAK-STAT signaling pathway as a potential target. We further showed that central memory CD4+ T cells were enriched with DNA from human herpesvirus 6b. Intervention via tofacitinib enabled disease control and tapering of other immunosuppressive agents. Tofacitinib, as well as antiviral agents, suppressed culprit-induced T cell proliferation in vitro, further supporting the roles of the JAK-STAT pathway and herpesviruses in mediating the adverse drug reaction. Thus, scRNA-seq analyses guided successful therapeutic intervention in the patient with refractory DiHS/DRESS. scRNA-seq may improve our understanding of complicated human disease pathophysiology and provide an alternative approach in personalized medicine.
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Affiliation(s)
- Doyoung Kim
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, Bethesda, MD, USA
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tetsuro Kobayashi
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, Bethesda, MD, USA
| | - Benjamin Voisin
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, Bethesda, MD, USA
| | - Jay-Hyun Jo
- Cutaneous Microbiome and Inflammation Section, Dermatology Branch, NIAMS, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Keiko Sakamoto
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, Bethesda, MD, USA
| | - Seon-Pil Jin
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, Bethesda, MD, USA
| | - Michael Kelly
- Cancer Research Technology Program, Single-Cell Analysis Facility, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Helena B Pasieka
- Department of Dermatology, MedStar Washington Hospital Center & Georgetown University Hospital, Washington, DC, USA
| | - Jessica L Naff
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jon H Meyerle
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ijeoma D Ikpeama
- Department of Laboratory Medicine, Clinical Center, NIH, Bethesda, MD, USA
| | - Gary A Fahle
- Department of Laboratory Medicine, Clinical Center, NIH, Bethesda, MD, USA
| | - Fred P Davis
- Molecular Immunology and Inflammation Branch, NIAMS, NIH, Bethesda, MD, USA
| | - Sergio D Rosenzweig
- Immunology Service, Department of Laboratory Medicine, Clinical Center, NIH, Bethesda, MD, USA
| | - Julie C Alejo
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Heidi H Kong
- Cutaneous Microbiome and Inflammation Section, Dermatology Branch, NIAMS, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Alexandra F Freeman
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
| | - Keisuke Nagao
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, Bethesda, MD, USA.
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99
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Santosa A, Yang SS, Chandran NS. DRESS Masquerading as Acute Cholecystitis. Am J Med 2020; 133:e56-e57. [PMID: 31421066 DOI: 10.1016/j.amjmed.2019.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Adinia Santosa
- Division of Dermatology, National University Hospital, Singapore
| | - Sam Shiyao Yang
- Division of Dermatology, National University Hospital, Singapore
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100
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Al-Attar M, De Santis M, Massarotti M. DRESS syndrome in response to Denosumab: First documented case report. Bone Rep 2020; 12:100239. [PMID: 31890758 PMCID: PMC6933223 DOI: 10.1016/j.bonr.2019.100239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 12/01/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022] Open
Abstract
Denosumab is an antiresorptive drug targeting RANK ligand, currently licensed for postmenopausal and male osteoporosis, bone loss associated with hormone ablation in men with prostate cancer and with systemic glucocorticoid treatment, and also used in oncology for the treatment of bone metastases and unresectable giant cell tumour of bone. When used for the treatment of osteoporosis or bone loss the drug is usually well-tolerated with non-specific musculoskeletal pain being the most common side effect. However denosumab has been associated with some dermatological manifestations including dermatitis, eczema, pruritus and, less commonly, cellulitis. All these side effects are generally mild and self-limiting. We hereby report the first documented case of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome following denosumab administration. DRESS syndrome is an extremely rare but potentially life-threatening hypersensitivity reaction. The syndrome should be considered in patients who present with new rash, eosinophilia and systemic organ dysfunction, especially when associated with new medications. Notably it has been previously reported in patients with osteoporosis treated with strontium ranelate but it has never been linked to any other antiosteoporotic drugs. Since the clinical manifestations of DRESS syndrome can span over a period of several months the diagnosis can frequently be quite difficult and it can become even more challenging in people taking denosumab and other drugs given in period doses, as both clinicians and patients are less likely to link the symptoms to the medication. Better recognition of DRESS syndrome is therefore needed, as well as awareness of the possibility of this reaction to occur in patients taking denosumab.
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Affiliation(s)
- Mariam Al-Attar
- Department of Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Ashton Road, Lancaster LA14RP, United Kingdom
| | - Maria De Santis
- Department of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Marco Massarotti
- Department of Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Ashton Road, Lancaster LA14RP, United Kingdom
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