Characterizing DRESS syndrome recurrence: a systematic review

Sharma, Ajay; Shwe, Samantha; Ravi, Vignesh; Miller, Marina; Mesinkovska, Natasha Atanaskova; Rojek, Nathan W.; Worswick, Scott

doi:10.1007/s00403-021-02274-3

Cited by 9 publications

(8 citation statements)

References 49 publications

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“…Lastly, our study confirmed the possibility of post‐acute complications of DRESS, either due to relapses (8.5%) or autoimmune sequelae (12.1%) such as thyroiditis. Previous studies found a similar complication rate 16,30 . This finding emphasizes that DRESS patients need a regular follow‐up beyond the acute phase for an early detection and management of such complications.…”

Section: Discussionsupporting

confidence: 72%

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Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases

Kridin

Brüggen

Walsh

et al. 2022

Acad Dermatol Venereol

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Background Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. Objective To explore treatment approaches across Europe and their impact on the disease course, as well as prognostic factors and culprit drugs. Methods In this retrospective European multicentric study, we included patients with probable or certain DRESS (RegiSCAR score ≥ 4) between January 2016 and December 2020. Independent associations between clinical parameters and the risk of intensive care unit admission and mortality at three months were assessed using a multivariable‐adjusted logistic regression model. Results A total of 141 patients from 8 tertiary centres were included. Morbilliform exanthem was the most frequent cutaneous manifestation (78.0%). The mean affected body surface area (BSA) was 67%, 42% of the patients presented with erythroderma, and 24.8% had mucosal involvement. Based on systemic involvement, 31.9% of the patients had a severe DRESS. Anticonvulsants (24.1%) and sulphonamides (22.0%) were the most frequent causative agents. In all, 73% of the patients were treated with systemic glucocorticoids, and 25.5% received topical corticosteroids as monotherapy. Few patients received antiviral drugs or anti‐IL5. No patients received intravenous immunoglobulins. The overall mortality was 7.1%. Independent predictors of mortality were older age (≥57.0 years; fully adjusted OR, 9.80; 95% CI, 1.20–79.93; p = 0.033), kidney involvement (fully adjusted OR, 4.70; 95% CI, 1.00–24.12; p = 0.049), and admission in intensive care unit (fully adjusted OR, 8.12; 95% CI, 1.90–34.67; p = 0.005). Relapse of DRESS and delayed autoimmune sequelae occurred in 8.5% and 12.1% of patients, respectively. Conclusions This study underlines the need for diagnostic and prognostic scores/markers as well as for prospective clinical trials of drugs with the potential to reduce mortality and complications of DRESS.

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Section: Discussionsupporting

confidence: 72%

“…Previous studies found a similar complication rate. 16,30 This finding emphasizes that DRESS patients need a regular follow-up beyond the acute phase for an early detection and management of such complications.…”

Section: Discussionmentioning

confidence: 92%

Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases

Kridin

Brüggen

Walsh

et al. 2022

Acad Dermatol Venereol

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“…The current study’s incidence of recurrence was lower than what has previously been reported in the literature (25%-59%) . The reasons for these differences are multifold, perhaps stemming from sample size differences (this study is the largest, to our knowledge), frequency of prescription of common culprit medications, or differing treatment regimens.…”

Section: Discussionmentioning

confidence: 99%

Predicting DRESS Syndrome Recurrence—The ReDRESS Score

et al. 2022

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“…The symptomatology of DS can sometimes be nonspecific; however, some frequent findings include fever, lymphadenopathy, and, although not mandatory, rash, which may be present in up to 100% of cases [92,128]. Hematological alterations frequently seen in laboratory analyses include leukocytosis with eosinophilia (>0.4 × 10 9 L) and/or the presence of atypical lymphocytes [129]. The degree of eosinophilia in our patient cohort did not show a statistically significant difference in terms of mortality, findings that are similar to prior studies on visceral manifestations of DS [8,10,100].…”

Section: Clinical Manifestations Of Renal Involvementmentioning

confidence: 99%

“…Optimal follow-up of the patient after complete recovery from DS is extremely important as recurrence can occur at any time after the resolution of the condition, ranging from months to years [129,164,165].…”

Section: Sequelaementioning

confidence: 99%

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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Characterizing DRESS syndrome recurrence: a systematic review

Cited by 9 publications

References 49 publications

Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases

Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases

Predicting DRESS Syndrome Recurrence—The ReDRESS Score

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

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