Bronchoscopic Investigation of Atypical Drug-induced Hypersensitivity Syndrome Showing Viral Lung Involvement

Hase, Isano; Arakawa, Hiroaki; Sasaki, Hideo; Kaneko, Fumio; Watanabe, Yuzuru; Fujiu, Koichi; Miyamoto, Hideaki; Ishii, Yoshiki

doi:10.2169/internalmedicine.55.6347

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…Because herpes virus reactivation and visceral infection may correlate with clinical severity, it logically follows that treatment of herpes viruses in DRESS may improve outcomes. In our case and other published cases, treatment with antiviral therapy may have been a helpful adjunct to systemic steroids. We would like to draw attention to several observations.…”

Section: Discussionsupporting

confidence: 61%

“…Our patient is not the first individual with DRESS reported to have visceral viral involvement. In one case of carbamazepine‐induced DRESS, bronchoscopic biopsy of lung tissue revealed inclusion bodies and multinucleated giant cells in alveolar cells suggestive of CMV infection. In another report, cutaneous and gastrointestinal CMV infection complicated the cases of two individuals with DRESS.…”

Section: Discussionmentioning

confidence: 99%

“…We would like to draw attention to several observations. First, viral reactivation and visceral infection (liver, pulmonary, gastrointestinal, cutaneous) are associated with, and may cause, DRESS . Second, the level of infection as measured according to viral antibody titers and viral load correlates with severity of DRESS.…”

Section: Discussionmentioning

confidence: 99%

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Use of antiviral medications in drug reaction with eosinophilia and systemic symptoms (DRESS): A case of infantile DRESS

Chow

Kim

Kamath

et al. 2018

Pediatric Dermatology

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A 3-month-old girl with Sturge-Weber syndrome presented with a morbilliform rash, eosinophilia, and fulminant liver failure to our tertiary pediatric hospital. She was diagnosed with drug reaction with eosinophilia and systemic symptoms complicated by viremia and evidence of viral hepatitis on liver biopsy. We discuss the role of viral reactivation in drug reaction with eosinophilia and systemic symptoms and the relevance of antiviral therapy in management.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Use of antiviral medications in drug reaction with eosinophilia and systemic symptoms (DRESS): A case of infantile DRESS

Chow

Kim

Kamath

et al. 2018

Pediatric Dermatology

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“…In published cases to date, the age of patients ranged from 4 to 77 years (mean 34 years) [4–25]. While extremes in age are a recognized risk factor in conditions like drug-induced interstitial lung disease (DILD), we did not observe any age predilection in DRESS.…”

Section: Resultsmentioning

confidence: 59%

“…Of these, 18 received only steroids (81%) and 3 patients (14%) received a combination of intravenous immunoglobulins (IVIG) and steroids. The duration of therapy is usually prolonged, and a slow taper over several weeks is necessary to avoid recurrence which has been documented in cases with more abrupt withdrawal [2, 4, 48]. In cases with significant gastrointestinal involvement, oral route of steroids should be avoided due to unpredictable absorption.…”

Section: Resultsmentioning

confidence: 99%

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

Taweesedt

Nordstrom

Stoeckel

et al. 2019

BioMed Research International

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Background The syndrome of drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, yet potentially fatal hypersensitivity reaction, most commonly associated with anticonvulsants, sulfonamides, and allopurinol. The reaction commonly manifests as a febrile skin eruption with lymphadenopathy and malaise between two and eight weeks following drug exposure. Internal organ involvement occurs in close to 90 percent of patients, and multiple organs may be involved in approximately half of those affected (most commonly the liver, kidney, and lung). Its long latency period and its variable clinical pattern of presentation have earned it the moniker of “the great mimicker,” with delays in diagnosis leading to higher morbidity and mortality. Although less commonly affected in DRESS syndrome, lung involvement is associated with more severe clinical course and potentially worse outcome. Pulmonary symptoms may precede development of the other more common symptoms and signs of the syndrome, or they might develop later in the course of the disease. Lung involvement in DRESS presents with a plethora of manifestations from mild cough or dyspnea with nonspecific interstitial changes on chest imaging to acute respiratory distress syndrome (ARDS) with life-threatening hypoxic respiratory failure. Methods We performed a systematic review of literature from the PubMed database and selected cases of definite DRESS syndrome as defined by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) with a score of 6 or more who also had pulmonary involvement. Demographic data, pattern of lung involvement, culprit medication, latency period, laboratory findings, therapy, and outcome were described and compared with the literature. Results The most common pulmonary radiographic findings in DRESS were interstitial infiltrates in 50% of cases, followed by acute respiratory distress syndrome (ARDS) 31%. Symptoms of cough and shortness of breath (SOB) were present in 72% of patients at the time of presentation. SOB was the more common presenting symptom (81%) compared to cough (19%). In 95% of cases, another visceral organ was involved (most commonly liver or kidneys). 45% of cases were initially misdiagnosed as pneumonia and were treated with empiric antimicrobials. In a multivariate regression, a latency of 30 days or less and an age of 60 or less were associated with development of ARDS. Gender and eosinophil count were not associated with severity of pulmonary manifestations. All patients recovered, and in the vast majority of cases (95%), parenteral steroids were used for treatment in addition to supportive care and symptomatic management. Conclusion Albeit rare, DRESS is a potentially life-threatening syndrome which may present with a myriad of pulmonary signs and symptoms. Pulmonary manifestations are less common but are typically seen in more severe cases. Pulmonary manifestations may be a presenting sign of DRESS, and timely recognition is important in order to stop offending medication and decrease morbidity a...

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Carbamazepine

2016

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Bronchoscopic Investigation of Atypical Drug-induced Hypersensitivity Syndrome Showing Viral Lung Involvement

Cited by 8 publications

References 22 publications

Use of antiviral medications in drug reaction with eosinophilia and systemic symptoms (DRESS): A case of infantile DRESS

Use of antiviral medications in drug reaction with eosinophilia and systemic symptoms (DRESS): A case of infantile DRESS

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

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