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Drug Reaction with Eosinophilia and Systemic Symptoms
Aka: Drug Reaction with Eosinophilia and Systemic Symptoms, DRESS Syndrome, Dilantin Hypersensitivity Syndrome, Anti-Convulsant Hypersensitivity Syndrome
- See Also
- Life-Threatening Drug-Induced Rashes
- Adverse Drug Reaction
- Hypersensitivity Reaction
- Anaphylaxis
- Penicillin Allergy
- Gell and Coombs Classification
- Fixed Drug Eruption
- Causes
- Anticonvulsants (most common, causes 50% of cases in children)
- Lamotrigine
- Phenobarbital
- Phenytoin
- Carbamazepine
- Other Causes
- Sulfonamide antibiotics
- Allopurinol
- Dapsone
- NSAIDs
- Aspirin
- HIV Medications
- Symptoms
- Pruritic rash
- Signs
- Onset 15-40 days (2-6 weeks) after offending medication exposure
- Skin findings
- Similar initial Morbilliform rash as with Fixed Drug Eruption
- Rash may be Macular
- Periorbital edema
- Swelling
- Follicular prominence
- Systemic findings
- Fever
- Lymphadenopathy
- Labs
- Complete Blood Count
- Leukocytosis
- Eosinophilia
- Comprehensive metabolic panel
- Renal Insufficiency
- Transaminitis (increased AST and ALT)
- Differential Diagnosis
- Fixed Drug Eruption
- Onset is earlier than DRESS Syndrome, typically <2 weeks after exposure
- Stevens-Johnson Syndrome
- Associated with greater mucous membrane involvement and less facial edema than DRESS Syndrome
- Management
- Stop the offending medication
- Admit to monitored setting
- High-dose Corticosteroids tapered over months
- IV Immunoglobulin And Plasmapheresis have also been used
- Complications
- Nephritis
- Arthritis
- Myositis
- Encephalitis
- Liver failure
- Prognosis
- Mortality approaches 10% (due to fulminant hepatic failure)
- References
- Behar and Claudius in Herbert (2020) EM:Rap 20(7): 8-9
- Jhun and DeClerck in Herbert (2015) EM:Rap 15(2): 9-11