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Role of Multiple Comorbidities and Therapies in Conditioning the Clinical Severity of DRESS: A Mono-Center Retrospective Study of 25 Cases. Int J Mol Sci 2021; 22:ijms22137072. [PMID: 34209467 PMCID: PMC8268599 DOI: 10.3390/ijms22137072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 12/14/2022] Open
Abstract
DRESS/DiHS is a complex and potentially fatal drug reaction. Little is known about risk factors and elements that can help to identify patients with a severe reaction early. The aim of the study was to investigate those factors favoring the disease and its severity by analyzing the clinical conditions and therapies preceding the reaction. We conducted a retrospective analysis on patients admitted to our center between 2010 and 2020 who were discharged with a diagnosis of DRESS. We used the RegiSCAR diagnostic criteria. We defined the severity of DRESS using the criteria of Mizukawa et al. We included 25 patients (15 females) with a median age of 66 years. Skin involvement, eosinophilia, and liver injury were the most important aspects. Allopurinol was found to be the most involved drug. Reaction severity was significantly associated with the number of daily medications (p = 0.0067) and an age of at least 68 years (p = 0.013). In addition, 75% of severe cases had at least three comorbidities in history, and most of the severe cases were female. In our study the advanced age, the high number of comorbidities and home therapies, and the inflammatory state were found to be predisposing elements to the development of the disease and its severity.
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Osada A, Arimitsu T, Nakazaki H, Kin T, Kaburagi S, Morita K, Nakajima Y, Kitahara H, Takahashi H, Hida M. Severe drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms in a 1-month-old infant with trisomy 21. J Dermatol 2021; 48:E496-E497. [PMID: 34184289 DOI: 10.1111/1346-8138.16042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Asami Osada
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Arimitsu
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Hisataka Nakazaki
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Takane Kin
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Sachiko Kaburagi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kumiko Morita
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Yuri Nakajima
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hirokazu Kitahara
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hayato Takahashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Hida
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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Chemokines in Severe Cutaneous Adverse Reactions (SCARs). Biomolecules 2021; 11:biom11060847. [PMID: 34204146 PMCID: PMC8228887 DOI: 10.3390/biom11060847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 12/19/2022] Open
Abstract
Although the incidence of severe cutaneous adverse reactions (SCARs) to medications is very low, SCARs can result in disability or even death if they are not diagnosed and treated properly. As the rapid recognition of SCARs is essential, it is necessary to develop diagnostic markers for them that can also be used to assess severity and predict outcomes in the early phase. In addition, it is important to identify novel therapeutic targets for SCARs. Chemokines are chemotactic cytokines that control the migratory patterns and locations of immune cells and usually exhibit markedly specific associations with certain human diseases. In Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), the Th1-associated chemokines chemokine (C-X-C motif) ligand 9 (CXCL9) and CXCL10 predominate, while in drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS), the levels of the Th2-associated chemokines chemokine (C-C motif) ligand 17 (CCL17) and CCL22 are markedly elevated. We suggest that the distinct chemokine profiles of SJS/TEN and DIHS/DRESS can be used to aid their differential diagnosis. CXCL10 has also been reported to be associated with the development of long-term sequelae in DIHS/DRESS. This review focuses on the chemokines involved in the pathogenesis and adjuvant diagnosis of SCARs, particularly SJS/TEN and DIHS/DRESS, but also provides a brief overview of SCARs and the chemokine superfamily. As it is being increasingly recognized that an association exists between human herpesvirus 6 (HHV-6) and DIHS/DRESS, the possible roles of the chemokine/chemokine receptor homologs encoded by HHV-6 in the pathogenesis of DIHS/DRESS are also discussed.
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Kawai R, Suzuki S, Tanaka A, Yamazaki M, Inoue T, Katagiri K. Association of lethal acquired factor XIII deficiency and type 1 diabetes mellitus with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms with high levels of serum thymus and activation-regulated chemokine. J Dermatol 2021; 48:e341-e342. [PMID: 33963600 DOI: 10.1111/1346-8138.15918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Rana Kawai
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - So Suzuki
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Akira Tanaka
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Marina Yamazaki
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tae Inoue
- Department of Dermatology, Saitama Red Cross Hospital, Koshigaya, Japan
| | - Kazumoto Katagiri
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
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Brin C, Bernigaud C, Hua C, Duong TA, Gaudin O, Colin A, de Prost N, Wolkenstein P, Chosidow O, Ingen-Housz-Oro S. Impact of systemic to topical steroids switch on the outcome of drug reaction with eosinophilia and systemic symptoms (DRESS): A monocenter retrospective study of 20 cases. Ann Dermatol Venereol 2021; 148:168-171. [PMID: 33858692 DOI: 10.1016/j.annder.2021.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/07/2020] [Accepted: 02/19/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is no consensus on the treatment of drug reaction with eosinophilia and systemic symptoms (DRESS). At our center, systemic steroids (SS) are used for severe cases while topical steroids (TS) are used for mild and moderate forms. OBJECTIVES To investigate the short-term outcome for patients with DRESS receiving SS as first-line therapy before being transferred to our department and then switched to TS after admission. METHODS A retrospective monocenter study in DRESS patients (RegiSCAR score≥4) transferred to our dermatology department from a different setting between 07/2012 and 06/2018 and who had received SS before being transferred. Epidemiological, clinical and laboratory data were collected, as well as details of treatment modalities and outcome. RESULTS Twenty patients were included. On admission to our department, 4 were assessed as having severe DRESS and continued on SS, while 16 were assessed as mild/moderate DRESS and were switched to TS. Among these 16 patients, the outcome on TS was favorable for 12 and quickly unfavorable for 4, who had to be switched back to SS. Retrospective analysis of the initial data (before transfer) showed that these 4 patients had previously had a greater number of severity criteria than the other 12. CONCLUSION Caution is needed not only when deciding to initiate SS in DRESS but also on withdrawal of these drugs. Our series suggests that when SS are used as first-line therapy in DRESS patients with initial severity criteria, they should not be withdrawn quickly for a switch to TS, even where progression appears favorable, due to the risk of relapse.
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Affiliation(s)
- C Brin
- Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - C Bernigaud
- Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Université Paris Est Créteil, EA7380 Dynamyc, EnvA, USC ANSES, rue du Général-Sarrail, 94010 Créteil cedex, France; Faculté de médecine de Créteil, université Paris-Est Créteil (UPEC), 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - C Hua
- Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Faculté de médecine de Créteil, université Paris-Est Créteil (UPEC), 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - T-A Duong
- Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - O Gaudin
- Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - A Colin
- Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - N de Prost
- Faculté de médecine de Créteil, université Paris-Est Créteil (UPEC), 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Service de réanimation médicale, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - P Wolkenstein
- Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Faculté de médecine de Créteil, université Paris-Est Créteil (UPEC), 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - O Chosidow
- Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Faculté de médecine de Créteil, université Paris-Est Créteil (UPEC), 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - S Ingen-Housz-Oro
- Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Université Paris Est Créteil, EpidermE, 94010 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Hsu YSO, Lu KL, Fu Y, Wang CW, Lu CW, Lin YF, Chang WC, Yeh KY, Hung SI, Chung WH, Chen CB. The Roles of Immunoregulatory Networks in Severe Drug Hypersensitivity. Front Immunol 2021; 12:597761. [PMID: 33717075 PMCID: PMC7953830 DOI: 10.3389/fimmu.2021.597761] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/18/2021] [Indexed: 12/12/2022] Open
Abstract
The immunomodulatory effects of regulatory T cells (Tregs) and co-signaling receptors have gained much attention, as they help balance immunogenic and immunotolerant responses that may be disrupted in autoimmune and infectious diseases. Drug hypersensitivity has a myriad of manifestations, which ranges from the mild maculopapular exanthema to the severe Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome (DRESS/DIHS). While studies have identified high-risk human leukocyte antigen (HLA) allotypes, the presence of the HLA allotype at risk is not sufficient to elicit drug hypersensitivity. Recent studies have suggested that insufficient regulation by Tregs may play a role in severe hypersensitivity reactions. Furthermore, immune checkpoint inhibitors, such as anti-CTLA-4 or anti-PD-1, in cancer treatment also induce hypersensitivity reactions including SJS/TEN and DRESS/DIHS. Taken together, mechanisms involving both Tregs as well as coinhibitory and costimulatory receptors may be crucial in the pathogenesis of drug hypersensitivity. In this review, we summarize the currently implicated roles of co-signaling receptors and Tregs in delayed-type drug hypersensitivity in the hope of identifying potential pharmacologic targets.
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Affiliation(s)
- Yun-Shiuan Olivia Hsu
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Lin Lu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yun Fu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chuang-Wei Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Chang Gung Immunology Consortium, Linkou, Taiwan
| | - Chun-Wei Lu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
- Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Fen Lin
- Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Cheng Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kun-Yun Yeh
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shuen-Iu Hung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Chang Gung Immunology Consortium, Linkou, Taiwan
| | - Wen-Hung Chung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Chang Gung Immunology Consortium, Linkou, Taiwan
- Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Dermatology, Chang Gung Hospital, Xiamen, China
- Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chun-Bing Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Chang Gung Immunology Consortium, Linkou, Taiwan
- Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Dermatology, Chang Gung Hospital, Xiamen, China
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
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Current Perspective Regarding the Immunopathogenesis of Drug-Induced Hypersensitivity Syndrome/Drug Reaction with Eosinophilia and Systemic Symptoms (DIHS/DRESS). Int J Mol Sci 2021; 22:ijms22042147. [PMID: 33670052 PMCID: PMC7927043 DOI: 10.3390/ijms22042147] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) is a severe type of adverse drug eruption associated with multiorgan involvement and the reactivation of human herpesvirus 6, which arises after prolonged exposure to certain drugs. Typically, two waves of disease activity occur during the course of DIHS/DRESS; however, some patients experience multiple waves of exacerbation and remission of the disease. Severe complications, some of which are related to cytomegalovirus reactivation, can be fatal. DIHS/DRESS is distinct from other drug reactions, as it involves herpes virus reactivation and can lead to the subsequent development of autoimmune diseases. The association between herpesviruses and DIHS/DRESS is now well established, and DIHS/DRESS is considered to arise as a result of complex interactions between several herpesviruses and comprehensive immune responses, including drug-specific immune responses and antiviral immune responses, each of which may be mediated by distinct types of immune cells. It appears that both CD4 and CD8 T cells are involved in the pathogenesis of DIHS/DRESS but play distinct roles. CD4 T cells mainly initiate drug allergies in response to drug antigens, and then herpesvirus-specific CD8 T cells that target virus-infected cells emerge, resulting in tissue damage. Regulatory T-cell dynamics are also suggested to contribute to the diverse symptoms of DIHS/DRESS. However, the pathomechanisms of this complex disease remain largely unknown. In particular, how viral infections contribute to the pathogenesis of DIHS/DRESS and why autoimmune sequelae arise in DIHS/DRESS are yet to be elucidated. This review describes the clinical features of DIHS/DRESS, including the associated complications and sequelae, and discusses recent advances in our understanding of the immunopathogenic mechanisms of DIHS/DRESS.
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Aoyama Y, Sugiyama S, Katayama C, Kamiya K. Risk factors for cytomegalovirus reactivation in autoimmune bullous disease patients on immunosuppressive therapy. Australas J Dermatol 2021; 62:e343-e344. [PMID: 33438199 DOI: 10.1111/ajd.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/01/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Yumi Aoyama
- Department of Dermatology, Kawasaki General Medical Center, Kawasaki Medical School, Okayama, Japan.,Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Seiko Sugiyama
- Department of Dermatology, Kawasaki General Medical Center, Kawasaki Medical School, Okayama, Japan.,Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Chieko Katayama
- Department of Dermatology, Kawasaki General Medical Center, Kawasaki Medical School, Okayama, Japan.,Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous drug reaction characterized by fever, lymphadenopathy, hematologic abnormalities, multisystem involvement, and viral reactivation. Although most patients with DRESS syndrome are able to fully recover, a subset of patients go on to have a prolonged course with recurrence, and/or autoimmune complications. Severe systemic involvement is associated with significant morbidity and mortality. Viral reactivation, especially of human herpes virus 6, Epstein-Barr virus, and cytomegalovirus, is a common feature of DRESS, with a high viral load and antibody titers being associated with poor outcomes. Aside from prompt discontinuation of the offending drug, treatment for patients with significant disease consists of systemic therapy with corticosteroids.
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Drug-related relapses in drug reaction with eosinophilia and systemic symptoms (DRESS). Clin Transl Allergy 2020; 10:52. [PMID: 33292540 PMCID: PMC7682085 DOI: 10.1186/s13601-020-00359-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Background A drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe T cell mediated hypersensitivity reaction. Relapses of symptoms in the recovery phase are frequent and linked to the reduction of the corticosteroid treatment, to viral reactivations or to the exposure to new drugs. Here, we analyzed, how often the exposure to new drugs leads to new sensitization or drug-related relapses without detectable sensitization. Methods 46 patients with DRESS treated in the allergy division of the Inselspital, Bern University Hospital, were retrospectively assessed. Drug-related relapses were analyzed in terms of frequency and whether a possible sensitization evaluated by skin tests and/or lymphocyte transformation tests (LTT) to the new drugs was detectable. Furthermore, drug tolerance was evaluated in a subset of patients. Results 56 relapses were observed in 27 of 46 patients with DRESS (58.7%). 33 (58.9%) of these relapses were associated with the use of new drugs, 30 drug-related relapses were evaluated by patch test and/or lymphocyte transformation test. In 8/30 (26.7%) drug-related relapses, a sensitization to the new drug was demonstrated, suggesting the emergence of a multiple drug hypersensitivity syndrome (MDH). 14 patients experienced 22 drug-related relapses without any detectable sensitization and only 1/6 patients developed new symptoms upon reexposure. Conclusion Patients with DRESS frequently suffered from drug related relapses. Half of the patients with drug-related relapses developed a MDH with proven sensitizations not only to the DRESS inducing drugs, but also to newly applied drugs. When not sensitized, drugs involved in drug related relapses could be reintroduced, if needed. Here, we propose a procedure for drug testing and future management of drug-related relapses in DRESS.
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Predictive biomarkers for cytomegalovirus reactivation before and after immunosuppressive therapy: A single-institution retrospective long-term analysis of patients with drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic syndrome (DRESS). Int J Infect Dis 2020; 100:239-246. [DOI: 10.1016/j.ijid.2020.08.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022] Open
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Shiohara T, Mizukawa Y. Comment on 'Drug reaction with eosinophilia and systemic symptoms syndrome in a patient with COVID-19': involvement of herpesvirus reactivations and adverse drug reactions in diverse cutaneous manifestations and overall disease severity of COVID-19. J Eur Acad Dermatol Venereol 2020; 35:e98-e100. [PMID: 32970885 PMCID: PMC7537195 DOI: 10.1111/jdv.16959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- T Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Y Mizukawa
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
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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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64
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Herman A, Matthews M, Mairlot M, Nobile L, Fameree L, Jacquet LM, Baeck M. Drug reaction with eosinophilia and systemic symptoms syndrome in a patient with COVID-19. J Eur Acad Dermatol Venereol 2020; 34:e768-e700. [PMID: 32735713 PMCID: PMC7436859 DOI: 10.1111/jdv.16838] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Affiliation(s)
- A Herman
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - M Matthews
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - M Mairlot
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - L Nobile
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - L Fameree
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - L-M Jacquet
- Cardiac ICU Department, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - M Baeck
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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65
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Katsuta M, Shiohara T, Asahina A. Refractory rheumatoid vasculitis complicated by cytomegalovirus reactivation as a manifestation of immune reconstitution inflammatory syndrome. JAAD Case Rep 2020; 6:652-655. [PMID: 32613063 PMCID: PMC7321787 DOI: 10.1016/j.jdcr.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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66
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Gupta SK, Sushantika S, Abdelmaksoud A. Sildenafil-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: Case report with review. Dermatol Ther 2020; 33:e13826. [PMID: 32543093 DOI: 10.1111/dth.13826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022]
Abstract
Sildenafil is one of the commonest over the counter drugs which is orally taken by the people for sexual enhancement. It is an inhibitor of phosphodiesterase type 5 (PDE5) and results in engorgement of carpora cavernosa and help in erectile dysfunction. There are fewer adverse cutaneous drug reactions reported by sildenafil perhaps due to use of the drug without medical prescription. Here we are reporting a case of sildenafil induced hypersensitivity syndrome that is possibly the first one and reviewing the medical literature on type of adverse cutaneous drug eruption due to sildenafil and other PDE5 inhibitors.
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Affiliation(s)
- Sunil K Gupta
- Department of Dermatology, All India Institute of Medical Sciences, Gorakhpur, India
| | - Sushantika Sushantika
- Department of Dermatology, All India Institute of Medical Sciences, Gorakhpur, India
| | - Ayman Abdelmaksoud
- Faculty, Mansoura Dermatology, Venereology & Leprology Hospital, Mansoura, Egypt
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67
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Bellón T, Kardaun SH. CXCL10/IP-10, an early biomarker for late sequelae in DRESS? Br J Dermatol 2020; 183:804-805. [PMID: 32338373 DOI: 10.1111/bjd.19113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- T Bellón
- Drug Hypersensitivity Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - S H Kardaun
- Department of Dermatology, Isala Diaconessenhuis, Meppel, the Netherlands
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68
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Tohyama M, Hashimoto K, Oda F, Namba C, Sayama K. Influence of corticosteroid therapy on viral reactivation in drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. J Dermatol 2020; 47:476-482. [PMID: 32162382 PMCID: PMC7754408 DOI: 10.1111/1346-8138.15294] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
Drug‐induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characteristically associated with sequential reactivation of herpesviruses, such as human herpesvirus 6 (HHV‐6), Epstein‐Barr virus (EBV), and cytomegalovirus (CMV). Since systemic corticosteroids are thought to result in viral reactivation due to their immunosuppressive effects, we clarified the influence of systemic corticosteroid therapy on viral reactivation in DIHS/DRESS. Viral DNA in peripheral whole blood and serum sIL‐2R level were measured during the disease course in twenty DIHS/DRESS patients. Six of seven patients treated without corticosteroids experienced HHV‐6 viremia associated with elevated serum sIL‐2R levels. In contrast, high‐dose corticosteroids started within 1 week after onset tended to inhibit the occurrence of HHV‐6 reactivation with remarkable suppression of serum sIL‐2R level. Low‐dose corticosteroids or late‐start high‐dose corticosteroids did not suppress occurrence of HHV‐6 viremia and the increase of sIL‐2R levels. HHV‐6 load in the blood was clearly correlated with the serum sIL‐2R level. On the other hand, increased CMV load were found in patients treated with corticosteroids regardless of the start time. The frequency of detection of EBV DNA in peripheral blood was similarly observed in all groups. In conclusion, high‐dose corticosteroids started within 1 week tended to suppress HHV‐6 reactivation through suppression of T cell activation. However, CMV proliferation was promoted by corticosteroids regardless of the start time. These observations suggested that careful consideration should be given to the dose and timing of administration of systemic corticosteroids in the treatment of DIHS/DRESS.
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Affiliation(s)
- Mikiko Tohyama
- Department of Dermatology, National Hospital Organization Shikoku Cancer Center, Matsuyama, 791-0280, Japan.,Department of Dermatology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Koji Hashimoto
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Fumiko Oda
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Chika Namba
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Koji Sayama
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
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69
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Abstract
Cutaneous adverse drug reactions are unpredictable and include various different skin conditions of varying degrees of severity. The most concerning are usually referred to as severe cutaneous adverse reactions (SCARs) and include acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DiHS) or hypersensitivity syndrome (HSS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). All are delayed type IV hypersensitivity reactions in which a T-cell-mediated drug-specific immune response is responsible for causing the disease. Nonetheless, specific T-cell subpopulations develop in response to certain environmental conditions and produce cytokines that orchestrate the various phenotypes. Cytotoxic T lymphocytes (CTLs), T-helper type 1 (Th1), Th2, Th17, and regulatory T cells (Treg), among other T-cell subpopulations, participate in the development of SCAR phenotypes. Cell subpopulations belonging to the innate immune system, comprising natural killer cells, innate lymphoid cells, monocytes, macrophages and dendritic cells, can also participate in shaping specific immune responses in various clinical conditions. Additionally, tissue-resident cells, including keratinocytes, can contribute to epidermal damage by secreting chemokines that attract pro-inflammatory immunocytes. The final phenotypes in each clinical entity result from the complex interactions between a variety of cell lineages, their products, soluble mediators and genetic and environmental factors. Although the pathophysiology of these reactions is not fully understood, intensive research in recent years has led to major progress in our understanding of the contribution of certain cell types and soluble mediators to the variability of SCAR phenotypes.
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Affiliation(s)
- Teresa Bellón
- La Paz Hospital Health Research Institute-IdiPAZ, Pº Castellana 261, 28046, Madrid, Spain.
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70
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Gelincik A, Cavkaytar O, Kuyucu S. An Update on the Management of Severe Cutaneous Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3881-3901. [DOI: 10.2174/1381612825666191106115556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/01/2019] [Indexed: 12/15/2022]
Abstract
Severe cutaneous drug hypersensitivity reactions involve of different mechanisms , some of which are
life-threatening, such as Stevens-Johnson syndrome/toxic epidermal necrolysis, drug reaction with eosinophilia
and systemic symptoms, acute generalized exanthematous pustulosis, generalized bullous fixed drug eruptions,
serum sickness and serum sickness-like reaction and drug-induced vasculitis. These reactions may have substantial
morbidity and mortality. In the past years, successive studies have provided new evidence regarding the
pathogenesis of some of these severe reactions and revealed that underlying mechanisms are highly variable.
Since these reactions have unique presentations and distinct pathomechanisms, the treatment methods and response
rates might be different among various entities. Although supportive and local therapies are sufficient in
some of these reactions, targeted immunosuppressive treatments and even mechanistic therapies such as plasmapheresis
may be required in severe ones. However, there is still insufficient evidence to support the best treatment
options for these patients since number of patients and large-scale studies are limited. In this review, conventional
and new treatment options for severe cutaneous drug hypersensitivity reactions are presented in detail in
order to provide the contemporary approaches to lessen the morbidity and mortality relevant to these severe iatrogenic
diseases.
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Affiliation(s)
- Aslı Gelincik
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Semanur Kuyucu
- Department of Pediatric Allergy and Immunology, Mersin University, Faculty of Medicine, Mersin, Turkey
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71
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Chan FL, Shear NH, Shah N, Olteanu C, Hashimoto R, Dodiuk-Gad RP. New Discoveries and Updates on Cutaneous Adverse Drug Reactions Presented at the 24th World Congress of Dermatology, Milan, Italy, 2019. Drug Saf 2019; 43:179-187. [PMID: 31673951 DOI: 10.1007/s40264-019-00880-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Felix L Chan
- Mississauga Academy of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nidhi Shah
- Department of Dermatology, BP Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Cristina Olteanu
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Rena Hashimoto
- Division of Dermatology, Keio University Hospital, Tokyo, Japan
| | - Roni P Dodiuk-Gad
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel. .,Department of Dermatology, Emek Medical Centre, Yitshak Rabin Boulevard 21, Afula, 1834111, Israel.
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72
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Hewitson LJ. Vancomycin induced DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) in a patient with tricuspid endocarditis. BMJ Case Rep 2019; 12:12/9/e229590. [PMID: 31527200 DOI: 10.1136/bcr-2019-229590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 57-year-old man presented for an elective pacemaker upgrade, complicated by the discovery of device infection. He had a background of complex congenital heart disease, including replacement of heart valves, and was treated for presumed infective endocarditis that was later confirmed by echocardiography. Antibiotic treatment, with intravenous vancomycin, was given as per the tissue sample sensitivities. On day 24 of treatment he deteriorated clinically, with the evolution of recurrent fever, epigastric pain, diarrhoea, widespread pruritic rash, lymphadenopathy and severe hypoxia over the subsequent 7-10 days. Blood tests revealed development of a marked eosinophilia, transaminitis and rising inflammatory markers. Further radiological imaging was non-diagnostic. On the basis of these clinical and biochemical features a diagnosis of drug reaction with eosinophilia and systemic symptoms syndrome was made. This led to the cessation of vancomycin, the offending agent and the referral for specialist immunology advice. He was subsequently treated with oral prednisolone and made a full recovery.
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73
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Krummenacher M, Banovic T, Kette F, Smith W, Hissaria P. Drug reaction with eosinophilia and systemic symptoms and cytomegalovirus colitis. Ann Allergy Asthma Immunol 2019; 123:401-403. [PMID: 31376489 DOI: 10.1016/j.anai.2019.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Affiliation(s)
| | - Tatjana Banovic
- SA Pathology, Royal Adelaide Hospital, Adelaide, South Australia
| | - Frank Kette
- Royal Adelaide Hospital, Adelaide, South Australia
| | | | - Pravin Hissaria
- SA Pathology, Royal Adelaide Hospital, Adelaide, South Australia
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74
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Shiohara T, Mizukawa Y. Drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS): An update in 2019. Allergol Int 2019; 68:301-308. [PMID: 31000444 DOI: 10.1016/j.alit.2019.03.006] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of this review was to provide an updated overview of drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS). Several new insights have been made, particularly with regards to the diagnosis, pathogenesis and care of some important complications and sequelae. The indication of herpesvirus reactivations in diagnosis in the assessment of disease severity is now better specified. Nevertheless, because fatal complications and autoimmune sequelae have been under-recognized, there is a clear need to identify effective parameters for assessing disease severity and predicting prognosis of the disease in the early phase. In this regard, we have established a scoring system that can be used to monitor severity, predict prognosis and stratify the risk of developing severe complications including fatal cytomegalovirus (CMV) disease. Regulatory T cells are likely to be central to the mechanism and would represent potential targets for therapeutic approaches that can ameliorate inflammatory responses occurring at the acute phase while preventing the subsequent development of harmful outcomes, such as CMV disease and autoimmune diseases.
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75
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Olteanu C, Shear NH, Morita E, Chung WH, Niihara H, Matsukura S, Hashimoto R, Dodiuk-Gad RP. The 10th International Congress on Cutaneous Adverse Drug Reactions, Shimane, Japan, 2018: Focus on New Discoveries. Drug Saf 2019; 42:797-801. [PMID: 31037651 DOI: 10.1007/s40264-019-00818-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Cristina Olteanu
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eishin Morita
- Department of Dermatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospitals, Linkou, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyüan, Taiwan
| | - Hiroyuki Niihara
- Department of Dermatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Setsuko Matsukura
- Department of Dermatology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan.,Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Rena Hashimoto
- Division of Dermatology, Keio University Hospital, Tokyo, Japan
| | - Roni P Dodiuk-Gad
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel. .,Department of Dermatology, Emek Medical Centre, Afula, Israel.
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