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The reaction to drugs with eosinophilia and systemic symptoms called DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is part of a broad spectrum called toxicodermias. The exact incidence is not known in children; However, a mortality rate that can be as high as 10% has been estimated in the literature. We present the case of a teenage patient with a personal history of bipolar affective disorder (BD), who received sertraline, quetiapine and trazodone on an outpatient basis. Due to the presence of hallucinations, lithium was added to the management. Ten days later she went to the emergency department due to the appearance of a skin rash and systemic symptoms, for which a clinical condition secondary to hypersensitivity to medications was suspected. [ABSTRACT FROM AUTHOR]

BACKGROUND: DRESS syndrome is a severe adverse reaction to a drug, which can cause multiorgan involvement when it is associated with the ingestion of allopurinol, which is a drug used in clinical practice for the treatment of hyperuricemia and gout, with a mortality rate of 10%. CLINICAL CASE: A 76-year-old female patient who, after taking allopurinol due to hyperuricemia, showed bumby, red, over raised, pruritic lesion on the body and the face. In addition, in the following 24 hours, she also presented edema and desquamation mainly in the face. With the help of complementary tests, such as leukocytosis with eosinophilia, we observed a deterioration of her renal function. However, after the suspension of the drug and the administration of corticosteroids patient improved. CONCLUSIONS: DRESS syndrome has a high risk of lethality; therefore, it is extremely important that physicians take the right steps such as the rapid suspension of drugs as well as therapeutic measurements to help minimize the risk. [ABSTRACT FROM AUTHOR]

Eosinophilia in not an uncommon findings in the intensive care unit (ICU); however, DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome, which is characterized by a hypersensitivity reaction to drugs and manifests as eosinophilia, systemic involvement and maculopapular erythematous rash 2-6 weeks after exposure to the offending drug, is an exceptional occurrence. We present the first case described in the literature of DRESS syndrome with pulmonary involvement in the form of interstitial pneumonitis and persistent adult respiratory distress syndrome (ARDS) secondary to proton pump inhibitors (PPI). The patient made a good recovery after withdrawal of the offending drug and long-term treatment with systemic corticosteroids. We also present a systematic review of all cases of DRESS with pulmonary involvement in the form of interstitial pneumonitis and cases of PPI-induced DRESS published to date; none of these describe pulmonary involvement., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

BACKGROUND: DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is associated with exposure to certain drugs. It is potentially fatal (20%), with significant dermatological manifestations and visceral involvement. The main treatment is the immediate withdrawal of the suspected drug, as well as the use of systemic corticosteroids. CLINICAL CASE: A 61-year-old female patient, who, after two weeks of ampicillin consumption, presented a generalized morbilliform skin rash, non-involving soles and palms, and also itchy and painful symmetrical erythematous plaques with lamellar scaling on the face and edema of lips and oral mucosa. Laboratory tests showed leukocytosis with eosinophilia and lymphocytosis as well as impaired kidney and liver function. The histopathological study described hyperkeratosis, spongiosis, and inflammatory infiltrates in the superficial dermis. CONCLUSIONS: DRESS syndrome is a rare and potentially fatal drug reaction, which should be suspected in the presence of a morbilliform rash, fever, hypereosinophilia, as well as visceral involvement, to establish a timely diagnosis and treatment to avoid complications such as multi-organ failure, as well as mortality. [ABSTRACT FROM AUTHOR]

DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome, also known as DIHS (drug-induced hypersensitivity syndrome), is an adverse and severe drug reaction. It has an estimated incidence of 1 case per 10,000 exposures to anticonvulsants, such as carbamazepine. The pathogenesis is considered type IVb hypersensitivity reaction triggered by the exposure of the related drug. The clinical presentation is characterized by fever, widespread skin lesions, internal organ compromise, a prolonged latent period and clinical course, and by a possible sequential reactivation of various human herpesvirus (HHV). The diagnosis of DRESS and DIHS is based on criteria established by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) and by the Japanese Research Committee on Severe Cutaneous Adverse Reaction (J-SCAR), respectively. Generally, the histopathological characteristics are not specific, as they are described as spongiotic dermatitis and drug reaction that commonly has eosinophils and apoptotic keratinocytes. Initial management requires the identification and prompt withdrawal of the related drug, besides support measures; nevertheless, corticosteroids are the mainstay treatment. The estimated mortality is 10%, primarily due to hepatic dysfunction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the clinical characteristics of DRESS syndrome in our study population and compare 4 different scoring scales from diagnostic criteria of this syndrome. MATERIALS AND METHODS: Observational, retrospective and cross-sectional study of patients with DRESS syndrome in Argentina. The study included 674 patients who were diagnosed as having an adverse cutaneous drug reaction diagnosed by clinical and histopathology judgment during the period 2007-2020. We emphasized in the comparison of diagnostic criteria: Bocquet, J-SCAR and RegiSCAR (Validation scoring and Notification and inclusion of cases). RESULTS: There were included 18 patients. The research has shown a prevalence of DRESS syndrome among women (average of diagnosis: 34 years old). 8/18 patients had an acute onset (≤ 15 days). Carbamazepine was the most implicated drug. Fever, pruritic rash with polyadenopathy, facial edema, and liver involvement were the most frequent clinical manifestations. At the biochemical level, we found leukocytosis with eosinophilia and increased liver transaminases. Both RegiSCAR were the most effective method to evaluate criteria. CONCLUSIONS: Both RegiSCAR were the most efficient, in special notification and inclusion of cases. We consider of little application in our country the J-SCAR criteria and it should only be considered when VRESS (viral reactivation with eosinophilia and systemic symptoms) is suspected. Finally, we propose modifications in some points of the criteria that we consider unclear. [ABSTRACT FROM AUTHOR]

BACKGROUND: Drug hypersensitivity syndrome, also known as DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), is an adverse reaction to medications and is life-threatening; dermatological manifestations are diverse and can cause significant multisystemic compromise. Diagnosis is a challenge due to the polymorphous rash of skin lesions, fever and multiorgan commitment. Treatment consists on the immediate withdrawal of the suspicious drug; systemic corticosteroids are the gold standard, depending on the severity, intravenous immunoglobulin or other immunosuppressive drugs can be added. CLINICAL CASE: A 37-year-old female patient, who three weeks after consumption of allopurinol had a generalized and symmetrical dermatosis, consisting of numerous macules that converged with each other to form a morbilliform pattern, with some skin-colored isolated spaces, also some papules that form erythematous-edematous plaques with ill-defined and blurred edges of apparently acute evolution. It was accompanied by itching, dry cough, fever, and adenomegalies. Laboratory tests showed eosinophilia and impaired kidney function. Histopathological study corresponded to interface dermatitis consistent with reactional dermatitis. CONCLUSIONS: It is important to know the clinical manifestations of DRESS syndrome, in order to have its early recognition and timely treatment, since although complete recovery is the usual course, mortality of up to 20-30% has been reported. [ABSTRACT FROM AUTHOR]

DRESS syndrome is a severe and idiosyncratic reaction of hypersensitivity to drugs, characterized by rash, fever, lymphadenopathy, hematological alterations and systemic compromise, the heterogeneity of the clinical presentation represents a diagnostic challenge for the clinician, a high clinical suspicion is required and the need to rule out a wide spectrum of differential diagnoses. Cutaneous reactions associated with drugs can be potentially fatal, early diagnosis can modify the patient's prognosis. We describe the clinical case and treatment of a 15-year-old male patient with chronic renal failure who was hospitalized for generalized morbilliform lesions associated with fever, lymphadenopathy, splenomegaly and eosinophilia. Complementary studies ruled out infectious, autoimmune and neoplastic processes; the antecedent of recent intake of allopurinol together with clinical and laboratory data allowed to establish a definitive diagnosis of DRESS syndrome. Patient received topical and systemic corticosteroids, clinical manifestations reverted from the second week of hospitalization. We emphasize the importance of identifying risk factors associated with the development of this syndrome. [ABSTRACT FROM AUTHOR]

DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), also called drug-induced hypersensitivity syndrome (DiHS), is a severe drug reaction that is characterized by rash, fever, lymphadenopathy, multi-organ impairment, eosinophilia and atypical lymphocytes. Liver, heart, kidneys and lungs are the most affected. We report the case of a 50-old-year woman with this illness, and diagnostic criteria, treatment and prognosis are reviewed. [ABSTRACT FROM AUTHOR]

Tuberculosis has increased all over the world. This paper reports the case of a male patient with tuberculous meningitis, spinal tuberculosis (Pott's disease) and severe adverse reactions to antituberculosis drugs. He had skin rash, hepatitis, eosinophilia and fever; all these signs make the diagnosis of DRESS syndrome. This syndrome is caused by a severe hypersensitivity reaction to different drugs. It is usually caused by anti-convulsants, sulfonamides and some antiviral drugs, among other drugs. Anti-tuberculosis drugs can also cause this potentially fatal syndrome. The importance of surveillance for early detection and treatment of adverse drug reactions is emphasized. [ABSTRACT FROM AUTHOR]