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%