Makindo Medical Notes

Related Subjects: Asthma |Acute Severe Asthma |Eosinophilic granulomatosis (Churg Strauss) |Loffler's syndrome (Pulmonary Eosinophilia) |Pulmonary Eosinophilia and CXR changes |Drug Reaction Eosinophilia Systemic Symptoms

The life-threatening potential of DRESS syndrome is high and the mortality is estimated to be around 10% in multiple studies

About

• Severe idiosyncratic drug reaction with a long latency period.
• Also known as anticonvulsant hypersensitivity syndrome

Aetiology

• Aromatic anticonvulsive drugs (carbamazepine, lamotrigine, phenobarbital)
• Drugs: minocycline, Allopurinol, abacavir, or nevirapine.
• Usually 2- to 6-week latency period for carbamazepine. Allopurinol.

Clinical: Potentially fatal

• Clinical symptoms, anywhere from 2 to 8 weeks after initiating the offending drug
• Fever, rash, urticarial, maculopapular eruption
• Vesicles, bullae, pustules, purpura, target lesions
• Facial oedema, cheilitis, and erythroderma
• SJS/TEN, erythema multiforme
• Hepatitis, pneumonitis, myocarditis, pericarditis, nephritis, and colitis

Investigations

• Eosinophilia, leukocytosis, and abnormal liver function tests,

Management

• Drug withdrawal, the earlier the better the prognosis.
• Supportive and symptomatic
• Corticosteroids often used, but the evidence is scant
• Ciclosporin may also be required

References

• Drug reaction with eosinophilia and systemic symptoms (DRESS)