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Urbonas V, Varnas D, Mociskiene K, Kvedariene V, Rudzeviciene O. Case Report: DRESS Syndrome Induced by Two Antituberculosis Drugs in an 8-Year-Old Girl. Front Pediatr 2022; 10:830611. [PMID: 35281232 PMCID: PMC8907915 DOI: 10.3389/fped.2022.830611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/17/2022] [Indexed: 12/19/2022] Open
Abstract
DRESS syndrome is defined as drug-induced hypersensitivity syndrome with rash, eosinophilia, and systemic symptoms. This syndrome is mostly associated with anticonvulsants, antibacterial and anti-inflammatory drugs. DRESS syndrome is a rare disease and is more frequently seen in adults. We present the first case report of DRESS syndrome in an 8-year-old girl, after 3 months of treatment with isoniazid and rifampicin. After discontinuation of drugs and a short course of prednisolone the girl recovered. After 5 years of follow-up, she is healthy and has no complaints but patch tests with isoniazid and rifampicin remain positive. The reported case emphasizes the importance of thorough medical history and including drug reactions in differential diagnosis.
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Affiliation(s)
- Vaidotas Urbonas
- Vilnius University Faculty of Medicine Clinic of Children's Diseases, Vilnius, Lithuania
| | - Dominykas Varnas
- Vilnius University Faculty of Medicine Clinic of Children's Diseases, Vilnius, Lithuania
| | - Kristina Mociskiene
- Vilnius University Faculty of Medicine Clinic of Children's Diseases, Vilnius, Lithuania
| | - Violeta Kvedariene
- Vilnius University Faculty of Medicine Clinic of Children's Diseases, Vilnius, Lithuania
| | - Odilija Rudzeviciene
- Vilnius University Faculty of Medicine Clinic of Children's Diseases, Vilnius, Lithuania
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Douilly C, Lepoix E, Azzouz B, Morel A, Trenque T. [DRESS syndrome to phenobarbital: A hypersensitivity reaction to drugs known but forgotten by prescribers-A case report]. Therapie 2021; 77:493-495. [PMID: 34088496 DOI: 10.1016/j.therap.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Camille Douilly
- Département de pharmacovigilance et pharmaco-épidemiologie, centre hospitalo-universitaire de Reims, avenue du Général Koening, 51092 Reims, France
| | - Elise Lepoix
- Département de pharmacovigilance et pharmaco-épidemiologie, centre hospitalo-universitaire de Reims, avenue du Général Koening, 51092 Reims, France.
| | - Brahim Azzouz
- Département de pharmacovigilance et pharmaco-épidemiologie, centre hospitalo-universitaire de Reims, avenue du Général Koening, 51092 Reims, France; EA 3797, faculté de médecine, université de Reims Champagne-Ardenne, 51100 Reims, France
| | - Aurore Morel
- Département de pharmacovigilance et pharmaco-épidemiologie, centre hospitalo-universitaire de Reims, avenue du Général Koening, 51092 Reims, France
| | - Thierry Trenque
- Département de pharmacovigilance et pharmaco-épidemiologie, centre hospitalo-universitaire de Reims, avenue du Général Koening, 51092 Reims, France; EA 3797, faculté de médecine, université de Reims Champagne-Ardenne, 51100 Reims, France
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Ksouda K, Affes H, Mahfoudh N, Chtourou L, Kammoun A, Charfi A, Chaabane H, Medhioub M, Sahnoun Z, Turki H, Tahri N, Hammami S, Zeghal K. HLA-A*31:01 and carbamazepine-induced DRESS syndrom in a sample of North African population. Seizure 2017; 53:42-46. [PMID: 29125944 DOI: 10.1016/j.seizure.2017.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Drug rash with eosinophilia and systemic symptoms (DRESS) is a serious adverse drug reaction. Carbamazepine is the most common causes of this syndrome. The HLA-A*31:01 allele has been shown to be strongly correlated with carbamazepine-induced DRESS syndrome in European, Japanese, Han Chinese and other asian population but not in African populations. So, our purpose is to study there is a correlation between HLA-A*31:01 and carbamazepine-induced DRESS syndrome in africain population? METHODS HLA class I (A and B) typing was performed on 7 subjects with carbamazepine-DRESS syndrome and 25 tolerants controls subjects. DNA typing HLA class I (A) alleles was checked by the polymerase chain reaction amplification Sequence Specific Oligonucleotide Probes (SSO) (reverse-SSO assay). High resolution HLA DNA Kit based on the Luminex technology (One Lambda®) was used according to the manufacturer's protocol. RESULTS The HLA-A*31:01 allele, which has a prevalence of 1% in Tunisian population, was significantly associated with DRESS syndrome. It was detected in 57.14% of cases (4/7) and only 4% of controls subjects (1/25). Thus, the carrier frequency of HLA-A*31:01 allele in the cases group was also significantly higher than in the controls group (57, 14% vs 4% P = 0,004). Odds ratio is estimated 32 (OR = 32 [2.6; 389.2]) CONCLUSION: Similarly to other ethnicities, the presence of the HLA-A*31:01 allele was associated with carbamazepine-DRESS syndrome in a sample of North African population. Future study must be conducted on a larger sample in order to confirm these results.
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Affiliation(s)
- Kamilia Ksouda
- Pharmacology Department, School of Medicine, Sfax, Tunisia.
| | - Hanen Affes
- Pharmacology Department, School of Medicine, Sfax, Tunisia
| | - Nedia Mahfoudh
- Immunology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Lassad Chtourou
- Gastroenterology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Arwa Kammoun
- Immunology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Aida Charfi
- Immunology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Hend Chaabane
- Dermatology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Molka Medhioub
- Pharmacology Department, School of Medicine, Sfax, Tunisia
| | - Zouhir Sahnoun
- Pharmacology Department, School of Medicine, Sfax, Tunisia
| | - Hamida Turki
- Dermatology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Nabil Tahri
- Gastroenterology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Serria Hammami
- Pharmacology Department, School of Medicine, Sfax, Tunisia
| | - Khaled Zeghal
- Pharmacology Department, School of Medicine, Sfax, Tunisia
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Silva-Feistner M, Ortiz E, Rojas-Lechuga MJ, Muñoz D. [DRESS syndrome in paediatrics: Clinical case]. ACTA ACUST UNITED AC 2017; 88:158-163. [PMID: 28288233 DOI: 10.1016/j.rchipe.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 05/30/2016] [Indexed: 12/17/2022]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening, drug-induced hypersensitivity reaction that includes skin eruption, haematological abnormalities, lymphadenopathy, and internal organ involvement. OBJECTIVE Presenting a rare condition in children, to facilitate a rapid diagnostic suspicion and recognition by doctors. CASE REPORT An 9 months old infant admitted due to a severe viral pneumonia, managed with non-invasive ventilation and ceftriaxone. Five days after stopping antibiotics, a confluent maculopapular rash appeared, which was predominantly in the trunk, face and upper extremities, combined with a fever, eosinophilia, and elevated serum levels of transaminase. She received treatment with oral prednisone and topical corticosteroids for 6 weeks, with a good outcome after 3 months. CONCLUSIONS The diagnosis of DRESS syndrome is made using clinical criteria, laboratory values, and histopathology, if there is any query. Although it is classically caused by anticonvulsants and sulphonamides, many other drugs have been implicated. The offending drug should be immediately discontinued and the patient given supportive treatment, and systemic corticosteroids for long periods of treatment.
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Affiliation(s)
- Marcos Silva-Feistner
- Departamento de Dermatología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elena Ortiz
- Departamento de Dermatología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Daniel Muñoz
- Departamento de Dermatología, Pontificia Universidad Católica de Chile, Santiago, Chile
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Díaz-Molina V, Tirado-Sánchez A, Ponce-Olivera R. Clinical, aetiological and therapeutic findings in Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, four years experience in a third-level Mexican hospital. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2016. [DOI: 10.1016/j.hgmx.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rabenkogo A, Vigue MG, Jeziorski E. [DRESS syndrome]. Arch Pediatr 2014; 22:57-62. [PMID: 25282466 DOI: 10.1016/j.arcped.2014.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/09/2014] [Accepted: 08/19/2014] [Indexed: 11/25/2022]
Abstract
DRESS syndrome (drug reaction eosinophilia and systemic symptoms) is a rare and serious drug toxidermia with potentially multiple organ dysfunctions. This report relates the case of a 9-year-old girl who presented a right cervical and mediastinal adenopathy with a mediastinal lump, fever, and deterioration of the general condition. The hospital assessment concluded in an abscess due to Staphylococcus aureus secreting a Panton-Valentine toxin with nonsevere pleuritis and pericarditis. The outcome was favorable with antibiotic treatment consisting of amoxicillin-acid clavulanic, amikacin, and clindamycin followed by oxacillin, rifampicin, and colchicine. On the 25th day of treatment, she presented recurrence of fever with a generalized rash, moderate hepatic cytolysis, hypereosinophilia, with the presence of activated lymphocytes that were further suggestive of visceral DRESS syndrome. A skin biopsy was performed that confirmed the diagnosis. The outcome was favorable after stopping all ongoing treatments even though none of the administered treatments were classically responsible for the syndrome. Symptomatic treatments (antihistaminic and topical steroids) were also administered. Patch tests, performed secondarily, were positive to penicillins; amoxicillin-clavulanic acid or oxacillin were then suspected of being responsible for the DRESS syndrome. Potentially serious, the DRESS syndrome should be considered together with atoxic epidermal necrolysis or Stevens-Johnson syndromes in the case of any rash appearing after drug administration, especially in the presence of face and eyelid edema.
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Affiliation(s)
- A Rabenkogo
- Service de maladies infectieuses pédiatriques, CHU de Montpellier Arnaud-De-Villeneuve, 371, avenue Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - M G Vigue
- Service de maladies infectieuses pédiatriques, CHU de Montpellier Arnaud-De-Villeneuve, 371, avenue Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - E Jeziorski
- Service de maladies infectieuses pédiatriques, CHU de Montpellier Arnaud-De-Villeneuve, 371, avenue Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
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Locharernkul C, Shotelersuk V, Hirankarn N. Pharmacogenetic screening of carbamazepine-induced severe cutaneous allergic reactions. J Clin Neurosci 2011; 18:1289-94. [PMID: 21802305 DOI: 10.1016/j.jocn.2010.12.054] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 11/03/2010] [Accepted: 12/12/2010] [Indexed: 10/17/2022]
Abstract
Recent studies associated the HLA-B 1502 allele with carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) in patients from China, Thailand and Malaysia. No association has been found in patients from Europe or Japan. Linkage summary reports from East and South-east Asia predict a highly significant odds ratio (OR) of 84.75 (95% confidence interval [CI]=42.53-168.91; p=8.96×10[-15]) with sensitivity and negative predictive values of 92% and 98%, respectively. The higher prevalence of HLA-B 1502 allele among certain Asian populations (10-15%) compared to Caucasians (1-2%) may explain a 10-fold to 25-fold higher incidence of CBZ-SJS/TEN in patients from Asia. Screening for HLA-B 1502 before using CBZ can prevent SJS/TEN in certain populations, but screening may be less beneficial in populations with low HLA-B 1502 allele frequency and in patients exposed to CBZ for more than 2 months. A retrospective study demonstrated that the costs of HLA-B 1502 screening were less than those of SJS treatment. This article reviews possible benefits and concerns of HLA-B 1502 screening in clinical practice.
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Affiliation(s)
- Chaichon Locharernkul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Abstract
The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. We used the RegiSCAR scoring system that grades DRESS cases as "no," "possible," "probable," or "definite" to classify cases reported in the literature. We also analyzed the clinical course and treatments of the cases. A total of 44 drugs were associated with the 172 cases reported between January 1997 and May 2009 in PubMed and MEDLINE. The most frequently reported drug was carbamazepine, and the vast majority of cases were classified as "probable/definite" DRESS cases. Hypereosinophilia, liver involvement, fever, and lymphadenopathy were significantly associated with "probable/definite" DRESS cases, whereas skin rash was described in almost all of the cases, including "possible cases." Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. The outcome was death in 9 cases. However, no predictive factors for serious cases were found. This better knowledge of DRESS may contribute to improve the diagnosis and management of this syndrome in clinical practice.
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