Drug reaction with eosinophilia and systemic symptoms: Difference between revisions
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== Background == |
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* T-cell mediated hypersensitivity reaction |
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* Characterized by fever, facial edema, maculopapular rash, lymphadenopathy, eosinophilia, atypical lymphocytosis, and multiorgan dysfunction |
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** Includes hepatitis, glomerulonephritis, arthritis, pneumonitis, and carditis |
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* Typical onset 2 to 8 weeks after starting medication |
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* Commonly-associated medications: |
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** Antibiotics, including [[vancomycin]] |
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*** Vancomycin-associated DRESS is more common in European descendents, with the HLA-A*32:01 allele |
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** Antiepileptic medications |
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** Allopurinol |
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* High mortality around 10% |
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*T-cell mediated hypersensitivity reaction |
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[[Category:Adverse events]] |
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== Clinical Manifestations == |
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*Characterized by [[fever]], facial edema, [[maculopapular rash]], [[lymphadenopathy]], [[eosinophilia]], [[atypical lymphocytosis]], and multiorgan dysfunction |
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**Includes [[hepatitis]], [[glomerulonephritis]], [[arthritis]], [[pneumonitis]], and [[carditis]] |
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*Typical onset 2 to 8 weeks after starting medication |
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*Commonly-associated medications: |
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**Antibiotics, including [[vancomycin]] |
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***[[Vancomycin]]-associated DRESS is more common in European descendants, with the HLA-A*32:01 allele |
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**[[Antiepileptic]] medications |
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**[[Allopurinol]] |
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*High mortality around 10% |
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== DRESS Scoring System == |
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* Developed for RegiSCAR, though I can't seem to find a primary reference |
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=== Criteria === |
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{| class="wikitable" |
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!Criterion |
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!-1 |
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!0 |
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!1 |
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!2 |
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!Notes |
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|Fever ≥38.5ºC |
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|No/U |
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|Yes |
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|Enlarged lymph nodes |
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|No/U |
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|Yes |
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|>1 cm in ≥2 areas |
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|Eosinophilia |
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|—Eosinophils (if WBC ≥4), or |
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|0.7-1.49 |
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|≥1.5 |
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|—Eosinophils (if WBC <4) |
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|10-19.9% |
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|≥20% |
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|Atypical lymphocytes |
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|No/U |
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|Yes |
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|Rash |
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|—Skin rash (%BSA) |
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|No/U |
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|>50% |
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|—Skin rash suggesting DRESS |
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|No |
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|U |
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|Yes |
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|≥2 of: purpuric lesions (other than legs), infiltration, facial edema, psoriasiform desquamation |
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|- |
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|—Biopsy suggesting DRESS |
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|No |
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|Yes/U |
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|Organ involvement |
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|—Liver involvement |
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|No/U |
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|Yes |
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| rowspan="5" |Maximum score of 2 |
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|—Kidney involvement |
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|No/U |
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|Yes |
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|—Muscle or heart involvement |
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|No/U |
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|Yes |
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|—Pancreas involvement |
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|No/U |
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|Yes |
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|—Other organ involvement |
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|No/U |
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|Yes |
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|Resolution ≥15 days |
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|No/U |
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|Yes |
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|Exclusion of other causes |
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|Yes |
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|at least 3 tests were done and negative: [[HAV]], [[HBV]], [[HCV]], [[ANA]], blood cultures, [[Mycoplasma]], [[Chlamydia]] |
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|} |
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=== Interpretation === |
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{| class="wikitable" |
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!Interpretation |
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!Points |
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|Definite |
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|≥6 |
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|Probable |
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|4-5 |
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|Possible |
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|2-3 |
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|Not DRESS |
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|≤1 |
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== Further Reading == |
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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] |
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[[Category:Adverse drug reactions]] |
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Latest revision as of 16:25, 2 January 2024
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
