Drug rash with eosinophilia and systemic symptoms syndrome

Changed by Yaïr Glick, 10 Mar 2022

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The drug rash with eosinophilia and systemic symptoms (DRESS) syndrome typically manifests as a skin rash, fever, lymph nodal enlargement with variable internal organ involvement, and represents a hypersensitivity reaction to medication.

Clinical presentation 

Clinical presentation can be variable and symptoms may arise from 2 to 8 weeks after initiating the offending drug. Typical clinical features include skin rash, fever, lymph node enlargement, and internal organ involvement. In terms of internal organ involvement, it most commonly involves the liver, followed by the kidneys and lungs.

Serum eosinophils are often elevated, i.e. eosinophilia 5.

Pathology

The pathophysiology of DRESS syndrome is not well known. Many drugs have been implicated as precipitants of this syndrome, including:

  • anticonvulsants
  • sulfonamides
  • dapsone
  • allopurinol
  • minocycline
  • gold salts

Radiographic features

CT

A CT chest is often non-specific but may show diffuse multifocal infiltrative opacification 5.

Treatment and prognosis

The prognosis can be variable but may carry a mortality of up to ~10% in patients with multiorgan involvement. Withdrawal of the causative drug and steroid therapy hashave traditionally been the mainstays of successful treatment. 

History and etymology

It was first described in 1996 by Bocquet et al 1.

  • -<p>The <strong>drug rash with eosinophilia and systemic symptoms (DRESS) syndrome</strong> typically manifests as a skin rash, <a href="/articles/pyrexia">fever</a>, <a href="/articles/lymph-node-enlargement">lymph nodal enlargement</a> with variable internal organ involvement, and represents a hypersensitivity reaction to medication.</p><h4>Clinical presentation </h4><p>Clinical presentation can be variable and symptoms may arise from 2 to 8 weeks after initiating the offending drug. Typical clinical features include skin rash, fever, lymph node enlargement, and internal organ involvement. In terms of internal organ involvement, it most commonly involves the liver followed by the kidneys and lungs.</p><p>Serum <a href="/articles/eosinophil">eosinophils</a> are often elevated, i.e. <a title="Eosinophilia" href="/articles/eosinophilia">eosinophilia</a> <sup>5</sup>.</p><h4>Pathology</h4><p>The pathophysiology of DRESS syndrome is not well known. Many drugs have been implicated as precipitants of this syndrome, including:</p><ul>
  • +<p>The <strong>drug rash with eosinophilia and systemic symptoms (DRESS) syndrome</strong> typically manifests as a skin rash, <a href="/articles/pyrexia">fever</a>, <a href="/articles/lymph-node-enlargement">lymph nodal enlargement</a> with variable internal organ involvement, and represents a <a title="Hypersensitivity reaction" href="/articles/hypersensitivity-reaction">hypersensitivity reaction</a> to medication.</p><h4>Clinical presentation </h4><p>Clinical presentation can be variable and symptoms may arise from 2 to 8 weeks after initiating the offending drug. Typical clinical features include skin rash, fever, lymph node enlargement, and internal organ involvement. In terms of internal organ involvement, it most commonly involves the liver, followed by the kidneys and lungs.</p><p>Serum <a href="/articles/eosinophil">eosinophils</a> are often elevated, i.e. <a href="/articles/eosinophilia">eosinophilia</a> <sup>5</sup>.</p><h4>Pathology</h4><p>The pathophysiology of DRESS syndrome is not well known. Many drugs have been implicated as precipitants of this syndrome, including:</p><ul>
  • -</ul><h4>Radiographic features</h4><h5>CT</h5><p>A CT chest is often non-specific but may show diffuse multifocal infiltrative opacification <sup>5</sup>.</p><h4>Treatment and prognosis</h4><p>The prognosis can be variable but may carry a mortality of up to ~10% in patients with multiorgan involvement. Withdrawal of the causative drug and steroid therapy has traditionally been the mainstays of successful treatment. </p><h4>History and etymology</h4><p>It was first described in 1996 by <strong>Bocquet </strong>et al<sup> 1</sup>.</p>
  • +</ul><h4>Radiographic features</h4><h5>CT</h5><p>A CT chest is often non-specific but may show diffuse multifocal infiltrative opacification <sup>5</sup>.</p><h4>Treatment and prognosis</h4><p>The prognosis can be variable but may carry a mortality of up to ~10% in patients with multiorgan involvement. Withdrawal of the causative drug and steroid therapy have traditionally been the mainstays of successful treatment. </p><h4>History and etymology</h4><p>It was first described in 1996 by <strong>Bocquet </strong>et al<sup> 1</sup>.</p>

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