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Drug rash with eosinophilia and systemic symptoms syndrome
From WikEM
Contents
Background
- Known as DRESS syndrome
- A severe adverse drug reaction
- Usually begins within 8 weeks of starting a new drug
- 8-10% mortality
- Previously known as Dilantin Hypersensitivity Syndrome or Anti-convulsant hypersensitivity syndrome
- However, many other medications, particularly antibiotics
Associated Drugs
- Most common
- phenytoin
- phenobarbital
- carbamazepine
- allopurinol
- sulfa drugs
- Others
- NSAIDS
- anti-retrovirals
- ACE inhibitors
- calcium-channel blockers
- Atypical antipsychotics (ziprasidone, olanzapine, etc.)[1]
- other antibiotics
Clinical Features
- Fever and rash (varying; may resemble SJS) are typically first signs
- +/- lymphadenopathy
- liver, kidney or hematologic system involvement
- atypical lymphocytes, thrombocytopenia
- Despite name, eosinophilia only in ~30% of casesScript errorScript error[citation needed]
Differential Diagnosis
- SJS/TENS
- Kawasaki Disease
- TTP
- See Rashes
Evaluation
- CBC with diff
- BMP
- Biopsy
Management
- Discontinue suspected drug
- Supportive care: anti-pyretic, anti-puritic
- Systemic steroids in severe cases (controversial)
- hepatitis, pneumonitis, extensive exfoliative dermatitis
- Family counseling as possible genetic component
Disposition
- Admit
See Also
External Links
References
- ↑ Herman AO. Antipsychotic Linked to Potentially Fatal Skin Reaction. Physician's First Watch. Dec 12, 2014. http://www.jwatch.org/fw109630/2014/12/12/antipsychotic-linked-potentially-fatal-skin-reaction?query=pfw&jwd=000013530619&jspc=.
Authors
Kenn Ghaffarian, Kevin Lu, Neil Young, Claire, Ross Donaldson, Daniel Ostermayer
