Drug reaction with eosinophilia and systemic symptoms - Revision history

Aidan at 20:35, 17 December 2024

2024-12-17T20:35:12Z

← Older revision		Revision as of 20:35, 17 December 2024
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	== Clinical Manifestations ==		== Clinical Manifestations ==

			*Prodrome of fever, malaise, sore throat, dysphagia, pruritus, and a burning sensation on the skin, followed by rash
	*~~Characterized~~ by [[fever]], facial edema, [[maculopapular rash]], [[lymphadenopathy]], [[eosinophilia]], [[atypical lymphocytosis]], and multiorgan dysfunction		*Symptoms include [[fever]], facial edema (which can cause new oblique earlobe creases), [[maculopapular rash]], [[lymphadenopathy]], [[eosinophilia]], [[atypical lymphocytosis]] (earliest and most common hematologic finding), and multiorgan dysfunction
	**Includes [[hepatitis]], [[glomerulonephritis]], [[arthritis]], [[pneumonitis]], and [[carditis]]		**Includes [[hepatitis]] (most common organ after skin), [[glomerulonephritis]], [[arthritis]], [[pneumonitis]], and [[carditis]]
			*Rash is typically morbilliform and spreads to involve more than 50% total body surface area
			**Lesions can be urticarial, eczematous, lichenoid, exfoliative, erythrodermic, targetoid, purpuric, vesicular, pustular, alone or in combination
			**About half have mild mucosal involvement
	*Typical onset 2 to 8 weeks after starting medication		*Typical onset 2 to 8 weeks after starting medication
	*Commonly-associated medications:		*Commonly-associated medications:
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	\|≤1		\|≤1
	\|}		\|}

			== Management ==

			* Cessation of offending medication
			* Most common treatment is [[prednisone]] 0.5 to 1 mg/kg (or equivalent glucocorticoid), tapered over 6 to 12 weeks once there is clinical improvement
			** No strong evidence to support this practice
			* If no improvement with prednisone at regular doses, can consider pulse steroids for 3 days
			* People have also tried [[IVIG]], [[Mycobacterium]], [[cyclosporine]], [[cyclophosphamide]], and several biologics (anti-IL5, anti-CD20, JAK inhibitors)
			* Resolution is slow, and can recur or relapse, and some patients are left with chronic complications

	== Further Reading ==		== Further Reading ==

Aidan at 20:59, 16 December 2024

2024-12-16T20:59:23Z

← Older revision		Revision as of 20:59, 16 December 2024
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	== Background ==		== Background ==

	*T-cell mediated ~~hypersensitivity~~ reaction		*T-cell mediated [[severe cutaneous adverse reaction]]

	== Clinical Manifestations ==		== Clinical Manifestations ==
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	*Typical onset 2 to 8 weeks after starting medication		*Typical onset 2 to 8 weeks after starting medication
	*Commonly-associated medications:		*Commonly-associated medications:
	**Antibiotics~~, including [[vancomycin]]~~		**Antibiotics
	**[[Vancomycin]]-associated DRESS is more common in European descendants, with the HLA-A32:01 allele		**[[Vancomycin]]-associated DRESS is more common in European descendants, with the HLA-A32:01 allele
			***[[Trimethoprim-sulfamethoxazole]]
	**[[Antiepileptic]] medications		**[[Antiepileptic]] medications: [[lamotrigine]] and [[carbamazepine]]
	**[[Allopurinol]]		**[[Allopurinol]]
	*High mortality around 10%		*High mortality around 5%

	== DRESS Scoring System ==		== DRESS Scoring System ==
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	* 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]		* 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]
			* Drug Reaction with Eosinophilia and Systemic Symptoms. ''NEJM''. 2024. Doi: [https://doi.org/10.1056/NEJMra2204547 10.1056/NEJMra2204547]

	[[Category:Adverse drug reactions]]		[[Category:Adverse drug reactions]]

Aidan at 16:25, 2 January 2024

2024-01-02T16:25:05Z

← Older revision		Revision as of 16:25, 2 January 2024
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	\|Yes		\|Yes
	\|		\|
	\|at least 3 tests were done and negative: HAV, HBV, HCV, ANA, blood cultures, Mycoplasma, Chlamydia		\|at least 3 tests were done and negative: [[HAV]], [[HBV]], [[HCV]], [[ANA]], blood cultures, [[Mycoplasma]], [[Chlamydia]]
	\|}		\|}

Aidan: /* DRESS Scoring System */

2024-01-02T16:24:30Z

DRESS Scoring System

← Older revision		Revision as of 16:24, 2 January 2024
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	\|		\|
	\|-		\|-
	\|Eosinophils (if WBC ≥4), or		\|—Eosinophils (if WBC ≥4), or
	\|		\|
	\|		\|
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	\|		\|
	\|-		\|-
	\|Eosinophils (if WBC <4)		\|—Eosinophils (if WBC <4)
	\|		\|
	\|		\|
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	\|		\|
	\|-		\|-
	\|Skin rash (%BSA)		\|—Skin rash (%BSA)
	\|		\|
	\|No/U		\|No/U
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	\|		\|
	\|-		\|-
	\|Skin rash suggesting DRESS		\|—Skin rash suggesting DRESS
	\|No		\|No
	\|U		\|U
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	\|≥2 of: purpuric lesions (other than legs), infiltration, facial edema, psoriasiform desquamation		\|≥2 of: purpuric lesions (other than legs), infiltration, facial edema, psoriasiform desquamation
	\|-		\|-
	\|Biopsy suggesting DRESS		\|—Biopsy suggesting DRESS
	\|No		\|No
	\|Yes/U		\|Yes/U
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	\|		\|
	\|-		\|-
	\|Liver involvement		\|—Liver involvement
	\|		\|
	\|No/U		\|No/U
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	\| rowspan="5" \|Maximum score of 2		\| rowspan="5" \|Maximum score of 2
	\|-		\|-
	\|Kidney involvement		\|—Kidney involvement
	\|		\|
	\|No/U		\|No/U
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	\|		\|
	\|-		\|-
	\|Muscle or heart involvement		\|—Muscle or heart involvement
	\|		\|
	\|No/U		\|No/U
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	\|		\|
	\|-		\|-
	\|Pancreas involvement		\|—Pancreas involvement
	\|		\|
	\|No/U		\|No/U
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	\|		\|
	\|-		\|-
	\|Other organ involvement		\|—Other organ involvement
	\|		\|
	\|No/U		\|No/U

Aidan at 16:23, 2 January 2024

2024-01-02T16:23:20Z

@@ Line 41: / Line 41: @@
+|
 |>1 cm in ≥2 areas
 |-
 |Eosinophils (if WBC ≥4), or
@@ Line 60: / Line 67: @@
 |No/U
 |Yes
+|
+|
@@ Line 80: / Line 94: @@
 |No
 |Yes/U
+|
+|

Aidan at 13:59, 13 November 2022

2022-11-13T13:59:22Z

@@ Line 14: / Line 14: @@
 **[[Allopurinol]]
 *High mortality around 10%
 [[Category:Adverse drug reactions]]

Aidan at 17:28, 20 August 2020

2020-08-20T17:28:39Z

← Older revision		Revision as of 17:28, 20 August 2020
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	*High mortality around 10%		*High mortality around 10%

	[[Category:Adverse ~~events~~]]		[[Category:Adverse drug reactions]]

Aidan at 14:07, 2 August 2020

2020-08-02T14:07:21Z

← Older revision		Revision as of 14:07, 2 August 2020
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			== Background ==
⚫	* T-cell mediated hypersensitivity reaction

⚫	* Characterized by fever, facial edema, maculopapular rash, lymphadenopathy, eosinophilia, atypical lymphocytosis, and multiorgan dysfunction
		⚫	*T-cell mediated hypersensitivity reaction
⚫	** Includes hepatitis, glomerulonephritis, arthritis, pneumonitis, and carditis

⚫	* Typical onset 2 to 8 weeks after starting medication
			== Clinical Manifestations ==
⚫	* Commonly-associated medications:

⚫	** Antibiotics, including [[vancomycin]]
		⚫	*Characterized by [[fever]], facial edema, [[maculopapular rash]], [[lymphadenopathy]], [[eosinophilia]], [[atypical lymphocytosis]], and multiorgan dysfunction
⚫	*** Vancomycin-associated DRESS is more common in European ~~descendents~~, with the HLA-A*32:01 allele
		⚫	**Includes [[hepatitis]], [[glomerulonephritis]], [[arthritis]], [[pneumonitis]], and [[carditis]]
⚫	** Antiepileptic medications
		⚫	*Typical onset 2 to 8 weeks after starting medication
⚫	** Allopurinol
		⚫	*Commonly-associated medications:
⚫	* High mortality around 10%
		⚫	**Antibiotics, including [[vancomycin]]
		⚫	**[[Vancomycin]]-associated DRESS is more common in European descendants, with the HLA-A32:01 allele
		⚫	**[[Antiepileptic]] medications
		⚫	**[[Allopurinol]]
		⚫	*High mortality around 10%

	[[Category:Adverse events]]		[[Category:Adverse events]]

Aidan: Created page with "* T-cell mediated hypersensitivity reaction * Characterized by fever, facial edema, maculopapular rash, lymphadenopathy, eosinophilia, atypical lymphocytosis, and multiorgan d..."

2019-10-08T16:07:22Z

Created page with "* T-cell mediated hypersensitivity reaction * Characterized by fever, facial edema, maculopapular rash, lymphadenopathy, eosinophilia, atypical lymphocytosis, and multiorgan d..."

New page

* T-cell mediated hypersensitivity reaction
* 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 descendents, with the HLA-A*32:01 allele
** Antiepileptic medications
** Allopurinol
* High mortality around 10%

[[Category:Adverse events]]