Search

Importance Drug-induced hypersensitivity syndrome (DIHS), also known as drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, is a potentially life-threatening reaction to medications with a mortality rate up to 10%. Standard therapy involves the use of systemic corticosteroids with tapering doses extending up to 9 months after the initial reaction. Alternative treatments for DIHS are needed, especially for patients for whom systemic corticosteroids are contraindicated. Objective To assess a short course of cyclosporine as first-line therapy for DIHS. Design, Setting, and Participants In this case series, 2 patients referred to the dermatology service of an academic tertiary care hospital and subsequently diagnosed as having DIHS were studied from December 1, 2013, through July 31, 2014. Interventions Short course (3-7 days) of cyclosporine. Main Outcomes and Measures Clinical and laboratory indicators were examined to determine the timing and efficacy of cyclosporine treatment. Results Two cases are reported of drug hypersensitivity reaction that were treated with cyclosporine, resulting in rapid and significant clinical improvement. The first case involved a woman in her 40s who developed DIHS after treatment with carbamazepine. A 7-day course of cyclosporine resulted in clinical resolution of the DIHS. The second case was that of a man in his 30s with minocycline-induced DIHS. A 3-day course of cyclosporine resulted in rapid and sustained clinical improvement. Conclusions and Relevance A short course of cyclosporine was of therapeutic benefit in the treatment of 2 patients with DIHS. Short courses of cyclosporine in the acute care setting may be an alternative to longer courses of systemic corticosteroids in the treatment of DIHS.

Importance Biochemical markers of disease allow clinicians to monitor disease severity, progression, and response to treatment. C-reactive protein and erythrocyte sedimentation rate are commonly used biochemical markers of inflammatory disease. We present 2 cases that indicate that D-dimer levels may be useful as a potential biochemical marker of disease activity in certain cutaneous inflammatory conditions. Observations We report 2 cases in which clinical disease activity correlates with D-dimer levels. The first case is a woman in her 50s with a diagnosis of cutaneous polyarteritis nodosa. The second case is a man in his 20s with recurrent urticaria. In both patients, plasma D-dimer levels increased with clinical evidence of disease activity and decreased with treatment and resolution of the disease flare. Interestingly, serum C-reactive protein levels did not correlate with disease activity and were found to be normal during clinically active disease. Conclusions and Relevance We show the potential value of D-dimer measurements as a marker of vasculocentric and/or vasculopathic inflammation and suggest that vascular endothelial damage may be ongoing in certain cutaneous inflammatory conditions.