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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|-
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|Fever ≥38.5ºC
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|No/U
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|Yes
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|
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|
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|
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|-
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|Enlarged lymph nodes
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|
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|No/U
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|Yes
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|
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|>1 cm in ≥2 areas
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|-
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|Eosinophilia
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|
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|
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|
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|
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|
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|-
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|—Eosinophils (if WBC ≥4), or
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|
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|
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|0.7-1.49
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|≥1.5
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|
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|-
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|&mdash;Eosinophils (if WBC <4)
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|
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|
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|10-19.9%
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|≥20%
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|
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|-
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|Atypical lymphocytes
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|
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|No/U
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|Yes
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|
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|
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|-
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|Rash
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|
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|
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|
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|
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|
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|-
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|&mdash;Skin rash (%BSA)
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|
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|No/U
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|>50%
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|
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|
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|-
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|&mdash;Skin rash suggesting DRESS
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|No
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|U
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|Yes
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|
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|≥2 of: purpuric lesions (other than legs), infiltration, facial edema, psoriasiform desquamation
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|-
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|&mdash;Biopsy suggesting DRESS
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|No
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|Yes/U
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|
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|
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|
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|-
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|Organ involvement
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|
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|
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|
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|
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|
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|-
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|&mdash;Liver involvement
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|
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|No/U
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|Yes
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|
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| rowspan="5" |Maximum score of 2
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|-
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|&mdash;Kidney involvement
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|
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|No/U
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|Yes
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|
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|-
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|&mdash;Muscle or heart involvement
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|
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|No/U
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|Yes
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|
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|-
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|&mdash;Pancreas involvement
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|
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|No/U
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|Yes
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|
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|-
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|&mdash;Other organ involvement
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|
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|No/U
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|Yes
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|
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|-
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|Resolution ≥15 days
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|No/U
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|Yes
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|
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|
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|
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|-
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|Exclusion of other causes
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|
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|
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|Yes
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|
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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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|-
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|Definite
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|≥6
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|-
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|Probable
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|4-5
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|-
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|Possible
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|2-3
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|-
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|Not DRESS
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|≤1
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|}
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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]]

Latest revision as of 12:25, 2 January 2024

Background

  • T-cell mediated hypersensitivity reaction

Clinical Manifestations

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

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