Drug reaction with eosinophilia and systemic symptoms: Difference between revisions

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**[[Allopurinol]]
  
**[[Allopurinol]]
 
*High mortality around 10%
  
*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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|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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|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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|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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|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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|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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|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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|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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|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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|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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|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]
   
 
[[Category:Adverse drug reactions]]
  
[[Category:Adverse drug reactions]]

Revision as of 09:59, 13 November 2022

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
Eosinophils (if WBC ≥4), or 0.7-1.49 ≥1.5
Eosinophils (if WBC <4) 10-19.9% ≥20%
Atypical lymphocytes No/U Yes
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
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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