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Caminati M, Brussino L, Carlucci M, Carlucci P, Carpagnano LF, Caruso C, Cosmi L, D’Amore S, Del Giacco S, Detoraki A, Di Gioacchino M, Matucci A, Mormile I, Granata F, Guarnieri G, Krampera M, Maule M, Nettis E, Nicola S, Noviello S, Pane F, Papayannidis C, Parronchi P, Pelaia G, Ridolo E, Rossi FW, Senna G, Triggiani M, Vacca A, Vivarelli E, Vultaggio A, de Paulis A. Managing Patients with Hypereosinophilic Syndrome: A Statement from the Italian Society of Allergy, Asthma, and Clinical Immunology (SIAAIC). Cells 2024; 13:1180. [PMID: 39056762 PMCID: PMC11274683 DOI: 10.3390/cells13141180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Hypereosinophilic syndrome (HES) encompasses a heterogeneous and complex group of different subtypes within the wider group of hypereosinophilic disorders. Despite increasing research interest, several unmet needs in terms of disease identification, pathobiology, phenotyping, and personalized treatment remain to be addressed. Also, the prospective burden of non-malignant HES and, more in general, HE disorders is currently unknown. On a practical note, shortening the diagnostic delay and the time to an appropriate treatment approach probably represents the most urgent issue, even in light of the great impact of HES on the quality of life of affected patients. The present document represents the first action that the Italian Society of Allergy, Asthma, and Clinical Immunology (SIAAIC) has finalized within a wider project aiming to establish a collaborative national network on HES (InHES-Italian Network on HES) for patients and physicians. The first step of the project could not but focus on defining a common language as well as sharing with all of the medical community an update on the most recent advances in the field. In fact, the existing literature has been carefully reviewed in order to critically integrate the different views on the topic and derive practical recommendations on disease identification and treatment approaches.
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Affiliation(s)
- Marco Caminati
- Asthma Centre and Allergy Unit, Center for Hypereosinophilic Dysimmune Diseases, Department of Medicine, University of Verona, 37124 Verona, Italy; (M.C.); (M.M.); (G.S.)
| | - Luisa Brussino
- SSDDU Immunologia Clinica ed Allergologia, AO Mauriziano, 10128 Turin, Italy; (L.B.); (S.N.)
| | - Matilde Carlucci
- Health Directorate, Verona Integrated University Hospital, 35134 Verona, Italy;
| | - Palma Carlucci
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, 70126 Bari, Italy; (P.C.); (E.N.)
| | | | - Cristiano Caruso
- Allergologia dell’Istituto di Clinica Medica del Policlinico Gemelli, Università Cattolica di Roma, 00168 Rome, Italy;
- UOSD DH Internal Medicine and Digestive Disease, Fondazione Policlinico A Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenzo Cosmi
- Department Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.C.); (P.P.)
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Simona D’Amore
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna “Guido Baccelli”, University of Bari Aldo Moro, Policlinico, 70126 Bari, Italy; (S.D.); (S.N.); (A.V.)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy;
| | - Aikaterini Detoraki
- Division of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity University of Naples Federico II, 80138 Naples, Italy;
| | - Mario Di Gioacchino
- Center for Advanced Studies and Technology (CAST), G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
- Institute of Clinical Immunotherapy and Advanced Biological Treatments, 66100 Pescara, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Ilaria Mormile
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
| | - Francescopaolo Granata
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
| | - Gabriella Guarnieri
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, 37129 Verona, Italy; (G.G.); (M.K.)
| | - Mauro Krampera
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, 37129 Verona, Italy; (G.G.); (M.K.)
| | - Matteo Maule
- Asthma Centre and Allergy Unit, Center for Hypereosinophilic Dysimmune Diseases, Department of Medicine, University of Verona, 37124 Verona, Italy; (M.C.); (M.M.); (G.S.)
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, 70126 Bari, Italy; (P.C.); (E.N.)
| | - Stefania Nicola
- SSDDU Immunologia Clinica ed Allergologia, AO Mauriziano, 10128 Turin, Italy; (L.B.); (S.N.)
| | - Silvia Noviello
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna “Guido Baccelli”, University of Bari Aldo Moro, Policlinico, 70126 Bari, Italy; (S.D.); (S.N.); (A.V.)
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, University Federico II, 80138 Naples, Italy;
| | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia “Seràgnoli”, 40126 Bologna, Italy;
| | - Paola Parronchi
- Department Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.C.); (P.P.)
- Immunology and Cell therapies Unit, University Hospital Careggi, 50134 Florence, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, 43124 Parma, Italy;
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
- WAO Center of Excellence, 80131 Naples, Italy
| | - Gianenrico Senna
- Asthma Centre and Allergy Unit, Center for Hypereosinophilic Dysimmune Diseases, Department of Medicine, University of Verona, 37124 Verona, Italy; (M.C.); (M.M.); (G.S.)
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, 84084 Fisciano, Italy;
| | - Angelo Vacca
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna “Guido Baccelli”, University of Bari Aldo Moro, Policlinico, 70126 Bari, Italy; (S.D.); (S.N.); (A.V.)
| | - Emanuele Vivarelli
- Department of Biomedicine, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy; (E.V.); (A.V.)
| | - Alessandra Vultaggio
- Department of Biomedicine, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy; (E.V.); (A.V.)
| | - Amato de Paulis
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
- WAO Center of Excellence, 80131 Naples, Italy
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Lemoine C, Zhou L, Phillips EJ, Blackley SV, Young M, Banerji A, King AJ, Blumenthal KG. Documentation of DRESS in the allergy list of patients with a prior history of DRESS. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00681-0. [PMID: 38969099 DOI: 10.1016/j.jaip.2024.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/30/2024] [Accepted: 06/23/2024] [Indexed: 07/07/2024]
Affiliation(s)
- Chantal Lemoine
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Rheumatology & Allergy Clinical Epidemiology Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Mass
| | - Li Zhou
- Harvard Medical School, Boston, Mass; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn; Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Suzanne V Blackley
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Marielle Young
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Andrew J King
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Rheumatology & Allergy Clinical Epidemiology Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Rheumatology & Allergy Clinical Epidemiology Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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Benarab S, Dezoteux F, Stien S, Dambricourt V, Duvert-Lehembre S. Asymptomatic Acute Pancreatitis and Fulminant Type 1 Diabetes Mellitus: A Rare and Life-Threatening Complication in Drug Reaction With Eosinophilia and Systemic Symptoms. Dermatitis 2024; 35:414-415. [PMID: 37910784 DOI: 10.1089/derm.2023.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Sarah Benarab
- Service de Dermatologie, Centre Hospitalier de Dunkerque, Dunkrik, France, Service de Dermatologie, Centre Hospitalo-Universitaire de Lille, Lille, France, Université de Lille, Lille, France
| | - Frederic Dezoteux
- Delphine Staumont-Sallé, MD, PhD, Service de Dermatologie, Centre Hospitalo-Universitaire de Lille, Lille, France, Inserm 1286, INFINITE, Lille Inflammation Translational Research Institute, Université Lille, Lille, France
| | - Sarah Stien
- Service de Dermatologie, Centre Hospitalier de Dunkerque, Dunkrik, France, Service de Dermatologie, Centre Hospitalo-Universitaire de Lille, Lille, France
| | | | - Sophie Duvert-Lehembre
- Service de Dermatologie, Centre Hospitalier de Dunkerque, Dunkrik, France, Service de Dermatologie, Centre Hospitalo-Universitaire de Lille, Lille, France
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Watanabe A, Nakamoto Y, Aita T, Naganuma T, Takahashi S, Kiko Y, Nakagawa H, Hamaguchi S. Fatal Myocarditis in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Without Mortality-Related Risk Factors: A Case Report and Literature Review. Cureus 2024; 16:e63541. [PMID: 39086788 PMCID: PMC11289355 DOI: 10.7759/cureus.63541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction characterized by skin rash, organ involvement, lymph node swelling, eosinophilia, and atypical lymphocytosis, with myocarditis being a rare but potentially fatal complication. It has been reported that in patients with cardiac involvement due to DRESS, older age and shorter periods between offending drug exposure and symptom onset are associated with mortality. We report a case of fatal DRESS-associated myocarditis in a young woman, occurring one month after drug exposure, despite intensive immunosuppressive therapy. This case report highlights the risk of mortality from DRESS-associated myocarditis even in patients lacking known risk factors.
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Affiliation(s)
- Aya Watanabe
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
| | - Yohei Nakamoto
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
| | - Tetsuro Aita
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
| | - Toru Naganuma
- Department of General Internal Medicine, Futaba Emergency and General Medicine Support Center, Fukushima Medical University, Fukushima, JPN
| | - Sei Takahashi
- Department of General Internal Medicine, Futaba Emergency and General Medicine Support Center, Fukushima Medical University, Fukushima, JPN
| | - Yuichiro Kiko
- Department of Diagnostic Pathology, Fukushima Medical University, Fukushima, JPN
| | - Hiroaki Nakagawa
- Department of General Internal Medicine, Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, JPN
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
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Inoue M, Sasamoto M, Ichihara R. Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome to Hemodialysis Polysulfone Membrane. Semin Dial 2024. [PMID: 38773824 DOI: 10.1111/sdi.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/05/2024] [Accepted: 05/04/2024] [Indexed: 05/24/2024]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe and potentially life-threatening hypersensitivity reaction. Although commonly associated with specific drugs, there have been no reports of DRESS syndrome caused by medical devices. We report a unique case of DRESS syndrome linked to a particular hemodialysis membrane during treatment. An 83-year-old man on hemodialysis exhibited fever, rash, and elevated eosinophils. Despite medication changes and consultations with specialists, his condition persisted. A drug-induced lymphocyte stimulation test revealed a positive response to the dialysis membrane. His symptoms and lab results met DRESS syndrome diagnostic criteria. After substituting the membrane and administering glucocorticoids, the patient displayed early improvement. Diagnosing DRESS syndrome is complex due to its varied presentation and lack of specific benchmarks. This instance underscores the need to consider medical devices as potential DRESS syndrome triggers. Enhanced physician awareness can facilitate prompt detection and proper management, ultimately refining patient outcomes.
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Nakazato S, Ogawa S, Oka K, Sano C, Ohta R. Chronic and Acute Drug-Induced Hypersensitivity Syndrome in a Rural Patient With Cytomegalovirus Infection: A Case Report. Cureus 2024; 16:e61376. [PMID: 38947678 PMCID: PMC11214545 DOI: 10.7759/cureus.61376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
A 50-year-old man presented with fever and a generalized rash, with chronic fatigue and lymphadenopathy for a year and a half. Initial tests ruled out lymphoproliferative disorders, showing reactive hyperplasia and cytomegalovirus. Symptoms worsened after ampicillin treatment, leading to suspected drug-induced hypersensitivity syndrome (DIHS). Upon admission, amoxicillin was discontinued, and prednisolone and antiviral treatment were initiated. The patient's condition improved with this therapy. A drug-induced lymphocyte stimulation test confirmed hypersensitivity to both ampicillin and allopurinol. This case illustrates the diagnostic challenge of chronic and acute DIHS because of the rare presentation. It underscores the need for high suspicion of DIHS in patients with chronic lymphadenopathy and fatigue, particularly with recent drug exposure. Effective management involves recognizing symptoms, withdrawing the offending drug, and using corticosteroids. Viral infections like cytomegalovirus can complicate DIHS diagnosis and treatment, necessitating a comprehensive approach. This case highlights the importance of considering DIHS in differential diagnoses and the complexities of managing it alongside co-infections in rural healthcare settings.
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Affiliation(s)
- Saaya Nakazato
- Family Medicine, Shimane University Faculty of Medicine, Izumo, JPN
| | - Shota Ogawa
- Family Medicine, Shimane University Faculty of Medicine, Izumo, JPN
| | - Kohei Oka
- Community Care, Unnan City Hospital, Unnan, JPN
| | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Peña-Blanco L, Gutiérrez-Soriano L, Montes FR, Barragán-Méndez A, Beltrán-Villegas S, López-Reyes JJ, Villa-Hincapié CA, Umaña JP. Heparin-induced DRESS syndrome in a paediatric patient and successful anaesthetic management in cardiovascular bypass surgery: case report. J Cardiothorac Surg 2024; 19:242. [PMID: 38632589 PMCID: PMC11022424 DOI: 10.1186/s13019-024-02722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a severe adverse drug reaction marked by delayed hypersensitivity reactions causing skin and systemic complications. DRESS diagnosis is challenging due to the variety of clinical presentations and symptom overlap with other conditions. The perioperative period in these patients requires precise pharmacological strategies to prevent complications associated with this syndrome. The treatment of DRESS induced by unfractionated heparin during cardiopulmonary bypass (CPB) surgery presents some challenges that must be considered when selecting an anticoagulant to avoid side effects. In this case, bivalirudin, a direct thrombin inhibitor, is indicated as an alternative to heparin in patients undergoing CPB. However, in contrast to heparin/protamine, there is no direct reversal agent for bivalirudin. CASE PRESENTATION We report the case of an 11-year-old male diagnosed with native aortic valve endocarditis and thrombosis in his left lower extremity. During valvular replacement surgery, systemic unfractionated heparin was administered. Postoperatively, the patient developed fever, eosinophilia and pruritic rash. Warm shock and elevated alanine transaminase (ALT) and aspartate transaminase (AST) levels followed, leading to the diagnosis of DRESS syndrome. Treatment with methylprednisolone resulted in complete resolution of symptoms. Seven years later, the patient was readmitted due to insufficient anticoagulation and a thrombus in the prosthetic aortic valve, presenting a recurrent DRESS episode due to the administration of unfractionated heparin, which was later replaced with low-molecular-weight heparin during hospitalization. Treatment with corticosteroids and antihistamines was initiated, resulting in the resolution of this episode. Ultimately, the patient required the Ross procedure. During this intervention the anticoagulation strategy was modified, unfractionated heparin was replaced with bivalirudin during the procedure and fondaparinux was administered during the postoperative period. This resulted in stable transaminases levels and no eosinophilia. CONCLUSION The severity of DRESS Syndrome underscores the importance of early recognition, heightened monitoring, and a comprehensive approach tailored to each patient's needs. This particular case highlights the significance of this approach and may have a substantial clinical impact since it provides alternatives to heparin, such as bivalirudin and fondaparinux, in the anticoagulation strategy of CPB for patients who have a hypersensibility reaction to this medication; thus, enhancing clinical outcomes by minimizing risks linked to adverse drug reactions.
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Affiliation(s)
- Laura Peña-Blanco
- Anesthesiology Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
| | - Laura Gutiérrez-Soriano
- Anesthesiology Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Félix Ramón Montes
- Anesthesiology Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Andrea Barragán-Méndez
- Anesthesiology Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Susana Beltrán-Villegas
- Anesthesiology Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Juan José López-Reyes
- Anesthesiology Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Carlos A Villa-Hincapié
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Juan Pablo Umaña
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
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O'Mahony S, Tobin AM, Donnelly TM. Severe DRESS with myocarditis secondary to naproxen/esomeprazole. BMJ Case Rep 2024; 17:e258187. [PMID: 38594198 PMCID: PMC11015319 DOI: 10.1136/bcr-2023-258187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
A man in his 60s presented with a widespread erythematous rash and associated chills, paraesthesia and haematuria. He had recently commenced naproxen/esomeprazole. Blood tests showed hypereosinophilia (0.73×109/L) and moderate acute kidney injury. Histology revealed parakeratosis, mild spongiosis with eosinophils. He developed acute coronary syndrome with rapid atrial fibrillation. Coronary angiogram was non-obstructive. Cardiac MRI (CMR) revealed acute myocarditis secondary to Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). Naproxen/esomeprazole was discontinued, and he was supported with oral corticosteroids. A repeat CMR 3 months later showed resolution of myocarditis. Naproxen/esomeprazole is not a common offending drug. DRESS is a rare drug-induced hypersensitivity reaction with a mortality rate of 10%. The objective of this case report is to highlight the significant but rare cardiac complications that can ensue from DRESS, which warrant prompt recognition and withdrawal of the causative drug.
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Affiliation(s)
- Sarah O'Mahony
- Dermatology, Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Ann-Marie Tobin
- Dermatology, Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
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Ahn SH, Ahn SJ, Kim SA, Lee HS, Chu K. Eosinophilic meningoencephalitis successfully treated with glucocorticoids and intravenous immunoglobulin: a case report. ENCEPHALITIS 2024; 4:40-46. [PMID: 38545640 PMCID: PMC11007548 DOI: 10.47936/encephalitis.2024.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/10/2024] Open
Abstract
Eosinophilic meningoencephalitis is a rare inflammatory condition of the central nervous system. As a limited number of cases has been reported, debate remains on the optimal treatment. We present a case of idiopathic eosinophilic meningoencephalitis successfully treated with glucocorticoids and intravenous immunoglobulin (IVIG). After extensive evaluation to rule out other possible causes, the patient was treated with intravenous (IV) dexamethasone and showed significant improvement within a few days. However, neurologic impairment persisted, and follow-up lumbar puncture results showed only a mild decrease in pleocytosis. Even after an additional 5 days of IV methylprednisolone, cerebrospinal fluid (CSF) pleocytosis persisted, and brain magnetic resonance imaging (MRI) showed an increase in enhanced lesions, implying persistent neuroinflammation. The patient was maintained on high-dose oral prednisolone for 2 months, and additional immune-modulatory effects were treated with IVIG. Follow-up MRI at 2 months showed a significant decrease in the extent of multiple enhanced lesions and a normalized CSF profile. The patient was maintained on regular maintenance doses of IVIG for an additional 6 months without any neurologic signs or symptoms. Inflammation is the key pathophysiology underlying neurological damage in eosinophilic meningoencephalitis. A literature review revealed that corticosteroid treatment is the only anti-inflammatory treatment used in cases of idiopathic meningoencephalitis, resulting in sufficient response in most patients but only partial response or death in a few cases. This is the first case report of IVIG use in idiopathic eosinophilic meningoencephalitis, suggesting the possibility of a new treatment modality for refractory cases.
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Affiliation(s)
- Soo Hyun Ahn
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seon-Jae Ahn
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Ae Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
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Morán-Mariños C, Llanos-Tejada F, Salas-Lopez J, Chavez-Huamani A, Casanova-Mendoza R, Villanueva-Villegas R. DRESS syndrome due to anti-TB drugs: A complex case with successful re-desensitization of group A drugs. J Family Med Prim Care 2024; 13:1555-1558. [PMID: 38827659 PMCID: PMC11141990 DOI: 10.4103/jfmpc.jfmpc_1516_23] [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: 09/12/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 06/04/2024] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, life-threatening adverse reaction caused by certain medications. Clinical findings usually include rash, fever, lymphadenopathy, and eosinophilia, and in some cases, they may affect major organs. This reaction caused by antituberculosis (TB) medication poses a public health risk due to treatment discontinuation, adherence, or success in cure. We present a 23-year-old female patient who developed DRESS syndrome as a result of group A anti-TB drugs (ATDs), an exceedingly rare occurrence. The patient's medication was successfully retrieved using a re-desensitization protocol.
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Affiliation(s)
- Cristian Morán-Mariños
- Unidad Especializada en Tuberculosis, Servicio de Neumologia, Hospital Nacional Dos de Mayo. Lima, Perú
- Unidad de Investigación en Bibliometria, Vicerrectorado de Investigación, Unidad San Ignacio de Loyola, Lima, Perú
| | - Felix Llanos-Tejada
- Unidad Especializada en Tuberculosis, Servicio de Neumologia, Hospital Nacional Dos de Mayo. Lima, Perú
- Instituto de Investigaciones en Ciencias Biomédicas - INICIB, Facultad de Medicina, Universidad Ricardo Palma, Lima, Perú
| | - Juan Salas-Lopez
- Unidad Especializada en Tuberculosis, Servicio de Neumologia, Hospital Nacional Dos de Mayo. Lima, Perú
| | | | - Renato Casanova-Mendoza
- Unidad Especializada en Tuberculosis, Servicio de Neumologia, Hospital Nacional Dos de Mayo. Lima, Perú
| | - Renzo Villanueva-Villegas
- Unidad Especializada en Tuberculosis, Servicio de Neumologia, Hospital Nacional Dos de Mayo. Lima, Perú
- Instituto de Investigaciones en Ciencias Biomédicas - INICIB, Facultad de Medicina, Universidad Ricardo Palma, Lima, Perú
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11
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Zhao Z, Lu M, Ying Y. Case Report: Minocycline-induced drug reaction with eosinophilia and systemic symptoms syndrome: a case report and literature review. Front Pharmacol 2024; 15:1355774. [PMID: 38515844 PMCID: PMC10955048 DOI: 10.3389/fphar.2024.1355774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Minocycline is a tetracycline commonly used for several dermatological diseases. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe adverse event which can be caused by minocycline. An 18-year-old male patient developed fever, acute rash, pharyngeal pain, lymphadenopathy, hematologic abnormalities, increased creatinine level, elevated liver enzyme levels, and splenomegaly 4 weeks after the oral treatment of minocycline, 100 mg daily, for acne. Once diagnosed with DRESS syndrome, intravenous methylprednisolone was applied and his clinical manifestations and laboratory results remarkably improved. Then, a total of 13 DRESS syndrome cases induced by minocycline were reviewed and their clinical characteristics were summarized. In these cases, only two patient (15.4%) was present with pharynx involved. In conclusion, we reported a rare minocycline-induced DRESS syndrome who developed fever, eosinophilia, acute rash, pharyngitis, lymphadenopathy, acute kidney injury, hepatitis, and splenomegaly. Our report provides detailed clinical features of minocycline-induced DRESS syndrome, which helps us further understand this severe adverse event.
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Affiliation(s)
- Zhe Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Ming Lu
- Department of Infectious Disease, Peking University Third Hospital, Beijing, China
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yingqiu Ying
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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12
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Beck J. DRESS syndrome: More than just a rash. JAAPA 2024; 37:1-4. [PMID: 38386937 DOI: 10.1097/01.jaa.0000997696.41400.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is rare but carries significant mortality and morbidity, making early identification and definitive management crucial. The diagnosis of DRESS is made clinically and involves consideration of a broad list of differential diagnoses. Given variable clinical presentations among patients with DRESS syndrome, clinicians should look for common findings and other hallmarks of the syndrome while monitoring for known complications. Additionally, clinicians should maintain a high index of suspicion to avoid missing more mild presentations, such as in this case patient with DRESS syndrome minor.
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Affiliation(s)
- James Beck
- James Beck practices in critical care at Emory University Hospital in Atlanta, Ga. The author has disclosed no potential conflicts of interest, financial or otherwise
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13
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Felix MMR, Kuschnir FC, Boechat JL, Castells M. Recent findings on drug hypersensitivity in children. FRONTIERS IN ALLERGY 2024; 5:1330517. [PMID: 38384771 PMCID: PMC10879301 DOI: 10.3389/falgy.2024.1330517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Drug hypersensitivity reactions (DHR) in children have a significant impact on clinical practice and public health. Both under-diagnosis (due to under-reporting) and over-diagnosis (due to the overuse of the term "allergy") are potential issues. The aim of this narrative review is to describe the most recent findings of DHR in children/adolescents and gaps regarding epidemiology, antibiotic allergy, antiepileptic hypersensitivity, vaccine allergy, and severe cutaneous adverse reactions (SCAR) in this age group.
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Affiliation(s)
- Mara Morelo Rocha Felix
- Department of General Medicine, School of Medicine and Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fábio Chigres Kuschnir
- Department of Pediatrics, Faculty of Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Laerte Boechat
- Clinical Immunology Service, Internal Medicine Department, Faculty of Medicine, Universidade Federal Fluminense, Niterói, Brazil
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Castells
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
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14
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Yildirim Arslan S, Sahbudak Bal Z, Guner Ozenen G, Bilen NM, Avcu G, Erci E, Kurugol Z, Gunay H, Tamsel İ, Ozkinay F. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome secondary to antimicrobial therapy in pediatric bone and joint infections. World Allergy Organ J 2024; 17:100850. [PMID: 38370132 PMCID: PMC10869939 DOI: 10.1016/j.waojou.2023.100850] [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: 05/21/2023] [Revised: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 02/20/2024] Open
Abstract
Background Bone and joint infections are common in children, particularly those under 10 years of age. While antimicrobial therapy can often successfully treat these infections, surgical drainage may also be necessary. It is important to note that prolonged courses of treatment have been associated with adverse events and drug reactions. Among these, drug reactions with eosinophilia and systemic symptoms (DRESS) syndrome is particularly severe and potentially life-threatening. We aimed to evaluate the cases of DRESS syndrome that develop during the treatment of bone and joint infections. Methods A retrospective study was conducted at a tertiary-level university hospital between 2015 and 2022 to determine the incidence and outcomes of definite DRESS Syndrome in children under 18 years of age with bone and joint infections. Results Of 73 patients with bone and joint infections, 16 (21.9 %) children developed antimicrobial therapy-induced DRESS syndrome. Eight (50 %) of these children were boys; the mean age of the patients was 9.76 ± 5.5 years. DRESS syndrome occurred in 16 children, including 13 children with osteomyelitis, 1 child with osteomyelitis and septic arthritis, and 2 children with septic arthritis and sacroiliitis. The mean duration of intravenous antibiotic therapy was 40.6 ± 16.6 days; the mean hospital stay was 48.7 ± 23.7 days; the mean time for the development of DRESS syndrome after starting antibiotics was 19.6 ± 7.68 days. New onset fever (68.8 %) and rash (43.8 %) were the most common symptoms of DRESS Syndrome. Cefotaxime and vancomycin were drugs responsible for DRESS syndrome in 8 (50 %) of 16. The causative antibiotics were switched to another class of antibiotic, most commonly preferred was ciprofloxacin (n:5; 31.3 %). For children with persistent symptoms, steroids were used in 5 (31.25) patients. Conclusions Clinicians should be aware of DRESS syndrome in children who develop fever and rash under long-term antibiotics and should check hematological and biochemical parameters to predict the severity of DRESS syndrome. In patients with persistent symptoms, steroids may be used to control the symptoms.
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Affiliation(s)
- Sema Yildirim Arslan
- Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
| | - Zumrut Sahbudak Bal
- Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
| | - Gizem Guner Ozenen
- Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
| | - Nimet Melis Bilen
- Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
| | - Gulhadiye Avcu
- Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
| | - Ece Erci
- Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
| | - Zafer Kurugol
- Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
| | - Huseyin Gunay
- Medical School of Ege University, Department of Orthopaedics and Traumatology, Izmir, Turkey
| | - İpek Tamsel
- Medical School of Ege University, Department of Radiology, Izmir, Turkey
| | - Ferda Ozkinay
- Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
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Kliniec K, Snopkowska A, Łyko M, Jankowska-Konsur A. Erythroderma: A Retrospective Study of 212 Patients Hospitalized in a Tertiary Center in Lower Silesia, Poland. J Clin Med 2024; 13:645. [PMID: 38337339 PMCID: PMC10856417 DOI: 10.3390/jcm13030645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
Erythroderma is a condition characterized by erythema affecting at least 90% of the skin surface area. It can be caused by various underlying conditions. Due to nonspecific clinical and laboratory findings, determining the cause may pose a challenge. In the retrospective study, we identified 212 patients hospitalized for erythroderma in the Department of Dermatology, Venereology, and Allergology at Wroclaw Medical University between January 2012 and March 2022. Clinical, laboratory, and histopathological features, as well as the management of patients, were studied. The median age of adults was 61 years (IQR = 47-68). The most common causes of erythroderma were psoriasis (n = 49, 24.01%), followed by atopic dermatitis (AD) (n = 27, 13.23%), and cutaneous T-cell lymphomas (CTCL) (n = 27, 13.23%). Despite laboratory tests and histopathological examination, the etiology of erythroderma remained undetermined in 39 cases (19.12%). In 70.59% of patients, it was the first episode of erythroderma, while 29.41% experienced a recurrent episode. Regardless of the etiology of erythroderma, patients were most frequently treated with systemic antihistamines (146 cases, 71.57%) and systemic steroids (132 cases, 64.71%). Patients with idiopathic erythroderma constitute the greatest diagnostic and therapeutic challenge, requiring particularly thorough evaluation.
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Affiliation(s)
- Katarzyna Kliniec
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.K.); (A.J.-K.)
| | - Aleksandra Snopkowska
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Magdalena Łyko
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.K.); (A.J.-K.)
| | - Alina Jankowska-Konsur
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.K.); (A.J.-K.)
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16
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Mąsior MN, Rostkowska OM, Furmańczyk-Zawiska A, Wieczorek-Godlewska R, Wyzgał M, Durlik M. DRESS Syndrome: Renal Involvement in Two Cases - A Comprehensive Analysis and Literature Review of Improved Diagnosis and Treatment. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942315. [PMID: 38204155 DOI: 10.12659/ajcr.942315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare hypersensitivity reaction involving the skin and various visceral organs; the kidneys are the second most affected organ. Many drugs are reported to be associated with DRESS, particularly antiepileptic agents and allopurinol. Certain human leukocyte antigen (HLA) haplotypes, in combination with a particular drug, can further contribute to an increased risk of DRESS. Symptoms often develop 2 to 8 weeks after drug initiation. If diagnosis is delayed, DRESS can be a life-threatening condition. CASE REPORT We present cases of 2 patients. The first patient was an 86-year-old Polish woman who developed acute kidney injury and skin lesions with accompanying leucocytosis and eosinophilia during long-term antibiotic therapy with piperacillin/tazobactam and ciprofloxacin. The second patient was a 37-year-old Asian woman with predialysis chronic renal disease stage V in the course of IgA nephropathy. Two weeks after starting allopurinol in a standard dose, she presented with maculopapular rash, facial edema, fever, liver injury, and eosinophilia. Renal function started to deteriorate, but she did not require dialysis. In both cases, the discontinuation of the above-mentioned drugs and the introduction of steroid therapy and intravenous immunoglobulins allowed for clinical improvement and recovery. In the second case, the extended 4-locus HLA typing was performed retrospectively, and allele HLA-B*5801 was found. CONCLUSIONS Due to the rare occurrence and heterogeneous manifestation of DRESS, its diagnosis can pose many difficulties. In-depth analysis of symptoms, medicines taken, and laboratory findings enable the implementation of appropriate treatment and recovery.
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Affiliation(s)
- Magdalena Natalia Mąsior
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Olga Maria Rostkowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Furmańczyk-Zawiska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Renata Wieczorek-Godlewska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Wyzgał
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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17
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Arora N, Chalasani N, Rahnama-Moghadam S. A review of drug-induced liver injury with rash, eosinophilia, and systemic symptoms (DRESS) syndrome: Cutaneous manifestations, clinical features, and management. Clin Liver Dis (Hoboken) 2024; 23:e0198. [PMID: 38831764 PMCID: PMC11146467 DOI: 10.1097/cld.0000000000000198] [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: 02/22/2024] [Accepted: 03/29/2024] [Indexed: 06/05/2024] Open
Affiliation(s)
- Nitin Arora
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Naga Chalasani
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University, Division of Gastroenterology, Department of Medicine, Indianapolis, Indiana, USA
| | - Sahand Rahnama-Moghadam
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Department of Dermatology, Indianapolis, Indiana, USA
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18
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Pires Pereira H, Coutinho IA, Carrapatoso I, Todo-Bom A. Drug Rash with Eosinophilia and Systemic Symptoms Syndrome Caused by Itraconazole in a 17-Year-Old Girl. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:143-146. [PMID: 37729075 DOI: 10.1089/ped.2023.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced hypersensitivity reaction. We report a case of DRESS syndrome in a 17-year-old female caused by itraconazole, confirmed by patch testing, that required treatment with both corticotherapy and cyclosporine. Our case highlights the importance of clinical suspicion of this syndrome in pediatric age and the novelty of an antifungal drug being identified as the culprit.
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Affiliation(s)
- Helena Pires Pereira
- Allergy and Clinical Immunology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Iolanda Alen Coutinho
- Allergy and Clinical Immunology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Isabel Carrapatoso
- Allergy and Clinical Immunology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Ana Todo-Bom
- Allergy and Clinical Immunology Department, Coimbra University Hospital Center, Coimbra, Portugal
- Allergy and Clinical Immunology Department, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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19
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Haward R, Haward R, Sharma JP. Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome Induced by Primary Anti-tubercular Medication: A Case Report. Cureus 2023; 15:e50753. [PMID: 38239535 PMCID: PMC10794811 DOI: 10.7759/cureus.50753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Drug reaction with eosinophilia and systemic syndrome (DRESS) is a life-threatening hypersensitivity reaction of the skin and visceral organs caused by exposure to certain drugs, often with a latency period of two to eight weeks. A 20-year-old man, previously diagnosed with pulmonary tuberculosis (TB) one month ago and receiving treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE regimen), presented with symptoms including a maculopapular rash, fever, elevated transaminase levels, an increased white blood cell count with eosinophilia, hepatomegaly, and lymphadenopathy. The patient experienced recovery upon cessation of drug use and was administered corticosteroids and supportive therapeutic interventions. Individuals diagnosed with pulmonary TB who are undergoing treatment with first-line anti-tubercular medications have a heightened susceptibility to DRESS. The timely identification and cessation of the offending agent can effectively mitigate mortality.
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Affiliation(s)
- Raymond Haward
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Rachel Haward
- Internal Medicine, Kurunji Venkatramana Gowda (KVG) Medical College & Hospital, Sullia, IND
| | - Jv Pranav Sharma
- General Surgery, Adesh Medical College and Hospital, Shahbad, IND
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20
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Cassalia F, Spiller A, Salmaso R, Caroppo F, Belloni Fortina A. DRESS syndrome in a patient undergoing stem cell transplantation: Can sirolimus be involved? Clin Case Rep 2023; 11:e7829. [PMID: 37663820 PMCID: PMC10472908 DOI: 10.1002/ccr3.7829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 09/05/2023] Open
Abstract
We present a case of sirolimus-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a stem cell transplant patient. Sirolimus is an immunosuppressive drug that inhibits the mammalian target of rapamycin (mTOR) pathway. A 24-year-old male with a history of acute lymphoblastic leukemia (ALL) underwent testicular extraction followed by hematopoietic stem cell transplantation (HSCT). He presented with pruritic eczematous lesions, which were initially treated with topical steroids. However, he later developed diffuse xerosis, fever, chills, generalized edema, weight gain, eosinophilia, and leukopenia. Skin biopsy showed spongiotic dermatitis with eosinophils, suggesting a drug or atopic reaction. Investigations ruled out infections, and the RegiSCAR score indicated drug reaction syndrome with eosinophilia and systemic symptoms (DRESS). Sirolimus, an immunosuppressive drug, was suspected as the cause. Sirolimus was discontinued, and oral steroids were initiated. After 3 weeks of therapy, the patient showed improvement with resolution of symptoms. Although no cases of sirolimus-induced DRESS syndrome have been reported, allergic reactions with eosinophilia induced by everolimus have been documented. In our case, the patient's history characterized by stem cell transplantation and multiple immunosuppressive therapies may have contributed to the development of DRESS syndrome after beginning sirolimus therapy. This case may be the first evidence of sirolimus-induced DRESS syndrome in a stem cell transplant patient.
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Affiliation(s)
- Fortunato Cassalia
- Dermatology UnitDepartment of Medicine (DIMED)University of PaduaPaduaItaly
| | - Alice Spiller
- Dermatology UnitDepartment of Medicine (DIMED)University of PaduaPaduaItaly
| | - Roberto Salmaso
- Dermatology UnitDepartment of Medicine (DIMED)University of PaduaPaduaItaly
| | - Francesca Caroppo
- Dermatology UnitDepartment of Medicine (DIMED)University of PaduaPaduaItaly
- Pediatric Dermatology Regional CenterDepartment of Women and Children's Health (SDB)University of PaduaPaduaItaly
- European Network for Rare Skin Disorders (ERN‐Skin)PaduaItaly
| | - Anna Belloni Fortina
- Dermatology UnitDepartment of Medicine (DIMED)University of PaduaPaduaItaly
- Pediatric Dermatology Regional CenterDepartment of Women and Children's Health (SDB)University of PaduaPaduaItaly
- European Network for Rare Skin Disorders (ERN‐Skin)PaduaItaly
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21
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Pacheco-Jiménez Y, Ríos-López J, Caballero-López C, López-García A, Rivero-Yeverino D, Papaqui-Tapia J, Armenta-Morales J. [Caso clínico: síndrome de DRESS por hidroxicloroquina]. REVISTA ALERGIA MÉXICO 2023; 70:201. [PMID: 37933942 DOI: 10.29262/ram.v70i3.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Background DRESS syndrome (Drug reaction with eosinophilia and systemic symptoms) is an idiosyncratic reaction characterized by peripheral eosinophilia and systemic symptoms: fever, exanthema, lymphadenopathy, hepatitis, atypical lymphocytes and elevated liver enzymes. The incidence is 1 per 10,000 exposures, mortality 10-20%. Treatment is based on suspension of the suspected drug and steroids. Case report A 42-year-old male with the following important antecedents. AHF: mother and father with Diabetes Mellitus type 2. APP: Arterial Hypertension, Diabetes Mellitus type 2, and bee sting allergy. Current Condition: He started 8 days after ingestion of hydroxychloroquine for probable SARS-COV-2 infection, with headache, facial and neck edema, desquamative dermatosis on trunk and upper extremities, went to private clinic with torpid evolution sent to third level for increased facial and neck edema, which merited orotracheal intubation, management with intravenous steroids and antihistamines. Labs on admission Leukocytes 20090, platelets 322 thousand, eosinophilia (5%), elevated liver enzymes and acute kidney injury, fulfilling J-SCAR criteria. The patient was discharged due to adequate evolution with follow-up by Allergy and Clinical Immunology, the patient persists with desquamative lesions after 4 weeks and normalization of laboratory parameters. Conclusions DRESS is a delayed adverse reaction. It is important the diagnostic presumption and the causal relationship with the drugs due to the high mortality rate.
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