Background
- T-cell mediated hypersensitivity reaction
Clinical Manifestations
- Characterized by fever, facial edema, maculopapular rash, lymphadenopathy, eosinophilia, atypical lymphocytosis, and multiorgan dysfunction
- Includes hepatitis, glomerulonephritis, arthritis, pneumonitis, and carditis
- Typical onset 2 to 8 weeks after starting medication
- Commonly-associated medications:
- Antibiotics, including vancomycin
- Vancomycin-associated DRESS is more common in European descendants, with the HLA-A*32:01 allele
- Antiepileptic medications
- Allopurinol
- Antibiotics, including vancomycin
- High mortality around 10%
DRESS Scoring System
- Developed for RegiSCAR, though I can't seem to find a primary reference
Criteria
| Criterion | -1 | 0 | 1 | 2 | Notes |
|---|---|---|---|---|---|
| Fever ≥38.5ºC | No/U | Yes | |||
| Enlarged lymph nodes | No/U | Yes | >1 cm in ≥2 areas | ||
| Eosinophilia | |||||
| —Eosinophils (if WBC ≥4), or | 0.7-1.49 | ≥1.5 | |||
| —Eosinophils (if WBC <4) | 10-19.9% | ≥20% | |||
| Atypical lymphocytes | No/U | Yes | |||
| Rash | |||||
| —Skin rash (%BSA) | No/U | >50% | |||
| —Skin rash suggesting DRESS | No | U | Yes | ≥2 of: purpuric lesions (other than legs), infiltration, facial edema, psoriasiform desquamation | |
| —Biopsy suggesting DRESS | No | Yes/U | |||
| Organ involvement | |||||
| —Liver involvement | No/U | Yes | Maximum score of 2 | ||
| —Kidney involvement | No/U | Yes | |||
| —Muscle or heart involvement | No/U | Yes | |||
| —Pancreas involvement | No/U | Yes | |||
| —Other organ involvement | No/U | Yes | |||
| Resolution ≥15 days | No/U | Yes | |||
| Exclusion of other causes | Yes | at least 3 tests were done and negative: HAV, HBV, HCV, ANA, blood cultures, Mycoplasma, Chlamydia |
Interpretation
| Interpretation | Points |
|---|---|
| Definite | ≥6 |
| Probable | 4-5 |
| Possible | 2-3 |
| Not DRESS | ≤1 |
Further Reading
- The DRESS Syndrome: A Literature Review. Am J Med. 2011;124(7):588-597. doi: 10.1016/j.amjmed.2011.01.017
