Allopurinol-Induced Drug Reaction With Eosinophilia and Systemic Symptoms

Myers, Charlene M; Miller, Jerry L.; Davis, Wesley D.

doi:10.1097/tme.0000000000000298

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…Despite that currently the pathogenesis of allopurinol-induced DRESS syndrome is only partially understood, it is thought to be multi-factorial and implicate at least three components [6]: first, the accumulation of allopurinol's metabolite which may directly cause cell damage. Second, genetic predisposition through specific human leukocyte antigen (HLA) allele's subtype.…”

Section: Discussionmentioning

confidence: 99%

Bacterial infection may trigger DRESS syndrome: an exceptional case of delayed hypersensitivity reaction occurring 22 months after allopurinol therapy

Souilem¹,

fatma²,

Lakhoua³

et al. 2023

Preprint

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Drug-induced hypersensitivity syndrome also known as DRESS syndrome is considered as a severe and potentially life-threatening adverse drug reaction. The pathogenesis of DRESS syndrome is still partially understood. Prior research has implicated viral infection or reactivation, specifically, human herpes viruses 6 and 7, Epstein-Barr virus and cytomegalovirus. We report a case of DRESS syndrome induced by allopurinol occurring 22 months after starting the treatment and which might have been triggered by concomitant infections. A 72-year-old man was put on allopurinol in February 2021. Twenty months later, he was hospitalized for Klebsiella urinary tract infection associated with erysipelas that had evolved well after two weeks of antibiotherapy. On November 20, he presented a second episode of Enterococcus faecalis urinary tract infection. On December 5, he developed a pruritic maculopapular rash with fever (39.5°C). Skin examination showed a generalized infiltrated erythematous maculopapular eruption and facial edema. Complete blood counts showed total leucocyte count at 10.6 × 10/µl with eosinophils at 1.58 × 10/µl (14.9%). Histological findings were compatible with DRESS syndrome. Allopurinol was stopped. Skin condition improved within a month. A prolonged delay between the start of treatment and the appearance of a febrile rash should never exclude the diagnosis of Dress syndrome or delay its management.

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Section: Discussionmentioning

confidence: 99%

Bacterial infection may trigger DRESS syndrome: an exceptional case of delayed hypersensitivity reaction occurring 22 months after allopurinol therapy

Souilem¹,

fatma²,

Lakhoua³

et al. 2023

Preprint

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“…There is no consensus or guideline for treating DRESS in the literature. So the treatment modalities are based mainly on case reports and expert opinions 33,34 . Although cessation of the offending drug promptly after the suspicion of drug reaction is of the utmost importance, steroids (1 mg/kg per day prednisolone or prednisolone equivalent) are the mainstay of treatment in cases of significant visceral organ involvement 8,9 .…”

Section: Discussionmentioning

confidence: 99%

“…So the treatment modalities are based mainly on case reports and expert opinions. 33,34 Although cessation of the offending drug promptly after the suspicion of drug reaction is of the utmost importance, steroids…”

Section: Managementmentioning

confidence: 99%

How to recognize and manage challenging DRESS cases: Two case reports and a review of the literature

Erdem

Durmuş

et al. 2022

Dermatologic Therapy

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon systemic adverse drug reaction. Furthermore, it is a unique syndrome encompassing various manifestations of fever, facial edema, eosinophilia, atypical lymphocytosis, and organ dysfunction. Since there are no large prospective studies concerning DRESS syndrome, current treatment modalities for DRESS have been mainly determined based on various case reports and expert opinions. Corticosteroids are the mainstay of therapy after the cessation of the culprit drug. Although most cases recover within a couple of months, some may persist and even progress despite 1 mg/kg/day of prednisolone or its equivalent. We herein present two cases of severe DRESS syndrome. Both cases presented with organ dysfunction and remained unresponsive to initial treatment with 1 mg/kg/day of intravenous methylprednisolone. Therefore, plasmapheresis or pulse steroid therapy (250 mg/day methylprednisolone for 3 days) was used. In the follow-up period, the patients' clinical conditions improved dramatically without recurrence. We aimed to share our experience in recognizing and managing severe DRESS cases in this manuscript. Furthermore, we reviewed the literature in comparison with the present cases. In conclusion, plasmapheresis or pulse steroid therapy (250 mg/day of methylprednisolone for 3 days) can be used to treat difficult DRESS cases where organ failure is about to happen.

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“…Analysis revealed the presence of interstitial nephritis in most cases of DS reviewed seen with granulomatous lesions, tubular atrophy, interstitial fibrosis, infiltration of mononuclear cells, eosinophils, lymphocytes, macrophages, and plasmocytes [14,15,17,20,22,23,31,32,36,39,41,43,50,56,63,64,69,77]. Tubular necrosis and vasculitis in some renal vessels were also observed [82].…”

Section: Renal Biopsy Findingsmentioning

confidence: 98%

Renal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of 71 Cases

Dagnon da Silva,

Domingues,

Oluic

et al. 2023

JCM

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Unlike other adverse drug reactions, visceral organ involvement is a prominent feature of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and correlates with mortality. The aim of this study was to systematically review cases published in PubMed-indexed, peer-reviewed journals in which patients had renal injury during the episode of DRESS syndrome (DS). We found 71 cases, of which 67 were adults and 56% were males. Female sex was associated with higher mortality. Chronic kidney disease (CKD) was present in 14% of patients who developed acute kidney injury (AKI) during DS. In 21% of cases, the kidneys were the only visceral organ involved, while 54% of patients had both liver and kidney involvement. Eosinophilia was absent in 24% of patients. The most common classes of medication associated with renal injury in DS were antibiotics in 34%, xanthine oxidase inhibitors in 15%, and anticonvulsants in 11%. Among antibiotics, vancomycin was the most common culprit in 68% of patients. AKI was the most common renal manifestation reported in 96% of cases, while isolated proteinuria or hematuria was present in only 4% of cases. In cases with AKI, 88% had isolated increase in creatinine and decrease in glomerular filtration (GFR), 27% had AKI concomitantly with proteinuria, 18% had oliguria, and 13% had concomitant AKI with hematuria. Anuria was the rarest manifestation, occurring in only 4% of patients with DS. Temporary renal replacement therapy was needed in 30% of cases, and all but one patient fully recovered renal function. Mortality of DS in this cohort was 13%, which is higher than previously reported. Medication class, latency period, or pre-existing CKD were not found to be associated with higher mortality. More research, particularly prospective studies, is needed to better recognize the risks associated with renal injury in patients with DS. The development of disease-specific biomarkers would also be useful so DS with renal involvement can be easier distinguished from other eosinophilic diseases that might affect the kidney.

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Allopurinol-Induced Drug Reaction With Eosinophilia and Systemic Symptoms

Cited by 6 publications

References 10 publications

Bacterial infection may trigger DRESS syndrome: an exceptional case of delayed hypersensitivity reaction occurring 22 months after allopurinol therapy

Bacterial infection may trigger DRESS syndrome: an exceptional case of delayed hypersensitivity reaction occurring 22 months after allopurinol therapy

How to recognize and manage challenging DRESS cases: Two case reports and a review of the literature

Renal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of 71 Cases

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