View source for Drug reaction with eosinophilia and systemic symptoms

== 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]]
*High mortality around 10%

== DRESS Scoring System ==

* Developed for RegiSCAR, though I can't seem to find a primary reference

=== Criteria ===
{| class="wikitable"
!Criterion
!-1
!0
!1
!2
!Notes
|-
|Fever ≥38.5ºC
|No/U
|Yes
|
|
|
|-
|Enlarged lymph nodes
|
|No/U
|Yes
|
|>1 cm in ≥2 areas
|-
|Eosinophilia
|
|
|
|
|
|-
|&mdash;Eosinophils (if WBC ≥4), or
|
|
|0.7-1.49
|≥1.5
|
|-
|&mdash;Eosinophils (if WBC <4)
|
|
|10-19.9%
|≥20%
|
|-
|Atypical lymphocytes
|
|No/U
|Yes
|
|
|-
|Rash
|
|
|
|
|
|-
|&mdash;Skin rash (%BSA)
|
|No/U
|>50%
|
|
|-
|&mdash;Skin rash suggesting DRESS
|No
|U
|Yes
|
|≥2 of: purpuric lesions (other than legs), infiltration, facial edema, psoriasiform desquamation
|-
|&mdash;Biopsy suggesting DRESS
|No
|Yes/U
|
|
|
|-
|Organ involvement
|
|
|
|
|
|-
|&mdash;Liver involvement
|
|No/U
|Yes
|
| rowspan="5" |Maximum score of 2
|-
|&mdash;Kidney involvement
|
|No/U
|Yes
|
|-
|&mdash;Muscle or heart involvement
|
|No/U
|Yes
|
|-
|&mdash;Pancreas involvement
|
|No/U
|Yes
|
|-
|&mdash;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 ===
{| class="wikitable"
!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: [https://doi.org/10.1016/j.amjmed.2011.01.017 10.1016/j.amjmed.2011.01.017]

[[Category:Adverse drug reactions]]