Drug reaction with eosinophilia and systemic symptoms syndrome is not uncommon and shows better clinical outcome than generally recognised

Allergol Immunopathol (Madr). 2015 Jan-Feb;43(1):19-24. doi: 10.1016/j.aller.2013.08.003. Epub 2014 Jan 2.

Abstract

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare disease which can cause severe morbidity and mortality. The aim of this study is to evaluate the clinical manifestation and course of DRESS syndrome.

Methods: We conducted a retrospective analysis of prospectively collected data in 45 patients with DRESS syndrome diagnosed between September 2009 and August 2011.

Results: The most common causative drug group was antibiotics (n=13, 28.9%), followed by anticonvulsants (n=12, 26.7%), antituberculosis drugs (n=6, 13.3%), non-steroidal anti-inflammatory drugs (n=4, 8.9%), undetermined agents (n=4, 8.9%), allopurinol (n=3, 6.7%), and others (n=3, 6.7%). The latency period ranged from 2 to 120 days, with a mean of 20.2 ± 24.3 days. The longest latency period was noted for the antituberculosis drug group, at 46.5 ± 29.9 days. Eosinophilia in peripheral blood examination was noted in 35 subjects (77.8%). Atypical lymphocytosis was noted in 16 patients (35.6%), and thrombocytopenia in seven patients (15.6%). Hepatic involvement was noted in 39 (86.7%) study patients, kidney in eight (17.8%), lung in four (8.9%), and central nervous system in one (2.3%). Systemic corticosteroids were administered to 10 patients (22.2%). Forty-three patients (95.6%) showed complete recovery, while two patients had poor outcomes.

Conclusions: DRESS syndrome was not more uncommon than generally recognised. Antibiotics were the most frequently implicated drug group, followed by anticonvulsants. Most patients with this disease showed a better clinical outcome than that which had been generally expected.

Keywords: Anticonvulsants; Drug hypersensitivity; Eosinophilia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Adult
  • Aged
  • Aged, 80 and over
  • Allergens / immunology
  • Anti-Bacterial Agents / immunology
  • Anticonvulsants / immunology
  • Antitubercular Agents / immunology
  • Drug Hypersensitivity Syndrome / diagnosis*
  • Drug Hypersensitivity Syndrome / drug therapy
  • Drug Hypersensitivity Syndrome / immunology
  • Eosinophilia / diagnosis*
  • Eosinophilia / drug therapy
  • Eosinophilia / immunology
  • Female
  • Humans
  • Kidney / pathology*
  • Liver / pathology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Allergens
  • Anti-Bacterial Agents
  • Anticonvulsants
  • Antitubercular Agents