Clinical, Viral and Genetic Characteristics of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in Shanghai, China

Wu, Xiaojin; Yang, Feng; Chen, Shengan; Xiong, Hao; Zhu, Qian; Gao, Xudong; Xing, Qinghe; Luo, Xiaoqun

doi:10.2340/00015555-2867

Cited by 30 publications

(24 citation statements)

References 23 publications

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“…Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome represents an severe adverse reaction after medication and is defined by the following elements: Skin symptoms, fever, lymph node enlargement, eosinophilia and modified lymphocytes, as well as internal organs dysfunction (1,2).…”

Section: Introductionmentioning

confidence: 99%

Severe DRESS syndrome after carbamazepine intake in a case with multiple addictions: A case report

et al. 2020

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A case is presented of a male with drug rash with eosinophilia and systemic symptoms (DRESS) syndrome induced by carbamazepine intake. The patient presented all the elements of DRESS syndrome: Skin reaction, fever, enlargement of the lymph nodes, increased eosinophils and lymphocytes, with associated organ dysfunctions. The patient was admitted with acute laryngeal edema and imminence of respiratory insufficiency. The escalation of symptoms for this syndrome is typical, even after the administering of the the culprit medicine has ceased. However, in this case, the most difficult aspect was the complex treatment scheme prior to admission. All medical compounds involved in the background treatment were substituted with other substances in order to control the immune response. Current knowledge regarding DRESS is reviewed and possible influence of various etiologies over the present case are discussed. Clinicians should be aware of this rare situation with life-threatening potential. We benefited from the advantage of reuniting the knowledge of a complex team of experts from various tertiary emergency units in Romania.

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Section: Introductionmentioning

confidence: 99%

Severe DRESS syndrome after carbamazepine intake in a case with multiple addictions: A case report

et al. 2020

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“…In terms of prognostic factors for HLH, our review does not support prior literature suggesting that low fibrinogen or cytopenia could predict mortality, but notably, our case only included cases of drug‐induced/DRESS‐associated HLH 32 . Our review does, however, support prior literature suggesting viral markers as a poor prognostic factor in both HLH and DRESS 33–35 . Of the 11 cases of confirmed herpesvirus reactivation, five (45%) had poor outcomes and mortality.…”

Section: Discussionmentioning

confidence: 71%

Overlap between hemophagocytic lymphohistiocytosis and drug reaction and eosinophilia with systemic symptoms: a review

et al. 2020

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Drug reaction and eosinophilia with systemic symptoms (DRESS), also known as drug‐induced hypersensitivity syndrome (DIHS), shares features with hemophagocytic lymphohistiocytosis (HLH), most notably fever, rash, and internal organ involvement. However, there is increasing recognition of drug‐induced (secondary) HLH and biopsy‐proven hemophagocytosis in DRESS, suggesting that HLH and DRESS not only overlap but also may be diseases on the same spectrum of immune dysfunction. To characterize existing literature on HLH/DRESS overlap, we queried the PubMed/MEDLINE database for 23 cases of HLH‐DRESS codiagnosis. Average time‐to‐onset of rash after exposure to inciting drug was 2.7 weeks. Fourteen cases (61%) clinically worsened despite initial therapy, prompting a workup with diagnosis of HLH on average 2.3 weeks after diagnosing DRESS. Nine cases met HLH diagnostic criteria and had a RegiSCAR score ≥4. Nine cases met one set of criteria with a presentation suggestive of the other. Five cases met neither criteria. A patient presenting with fever, generalized rash, bicytopenia, and internal organ involvement after drug exposure was most predictive of meeting diagnostic criteria for both HLH and DRESS. Treatment was highly variable, although most initiated systemic corticosteroids with/without IVIG, plasmapheresis, or etoposide. Patients with poor outcomes in this review were treated using steroid monotherapy and had viral reactivation. Dermatologists should consider the possibility of HLH in any patient presenting with fever, rash, internal organ involvement, and cytopenia. Additional studies will be necessary to further characterize HLH and DRESS overlap and determine optimal management.

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“…Whilst downstream processing does require a degree of expertise, centralisation of this would reduce technical variability. It also remains possible that by subjecting greater numbers of cases to molecular profiling, patterns in the gene signature signal could identify hereto-unrecognised DRESS endotypes characterised by a correlation between clinical features and molecular signature (5, 6, 8, 31–34). A wholly ex vivo diagnostic test is safe and requires only a minimal amount of blood sampling from patients.…”

Section: Discussionmentioning

confidence: 99%

“…The liver is the most commonly involved among the organs, found in 51–94.2% of patients; followed by renal involvement, lung, cardiac and central nervous system (4–7). Future lifelong avoidance of the culprit drug is crucial as DRESS can be life-threatening, reported mortality being 2-6% (2, 4, 8). Confirmation of causality can be difficult if the culprit drug is not clinically obvious.…”

Section: Introductionmentioning

confidence: 99%

Molecular diagnosis of causality in T cell mediated severe cutaneous adverse drug reactions

Teo

Haw

Vallejo

et al. 2021

Preprint

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Background: One of the most severe forms of T cell mediated cutaneous adverse drug reactions is drug reaction with eosinophilia and systemic symptoms (DRESS), hence subsequent avoidance of the causal drug is imperative. However, attribution of drug culpability in DRESS is challenging and standard skin allergy tests are not recommended due to for patient safety reasons. We sought to identify potential biomarkers for development of a diagnostic test. Methods: Peripheral blood mononuclear cells (PBMCs) from a discovery cohort (n=5) challenged to drug or control were analysed for transcriptomic profile. A signature panel of genes was then tested in a validation cohort (n=6), and compared to tolerant controls and other inflammatory conditions which can clinically mimic DRESS. A scoring system to identify presence of drug hypersensitivity was developed based on gene expression alterations of this panel. Results: Whole transcriptome analysis identified 4 major gene clusters including those regulating T cell activation via NFAT and cytokine receptor activity. 22 differentially expressed gene transcripts were identified as a DRESS signature including Type 1 interferon pathways and Th2 activation. The DRESS transcriptomic panel identified antibiotic-DRESS cases in a validation cohort but was not altered in other inflammatory conditions. Machine learning or differential expression selection of a biomarker panel showed high sensitivity and specificity (100% and 85.7-100% respectively) for identification of the culprit drug in DRESS. Conclusion: Transcriptomic analysis of DRESS revealed important insights into the key activated pathways and identified a transcriptional signature which shows potential as a test with high sensitivity for drug culpability attribution.

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Clinical, Viral and Genetic Characteristics of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in Shanghai, China

Cited by 30 publications

References 23 publications

Severe DRESS syndrome after carbamazepine intake in a case with multiple addictions: A case report

Severe DRESS syndrome after carbamazepine intake in a case with multiple addictions: A case report

Overlap between hemophagocytic lymphohistiocytosis and drug reaction and eosinophilia with systemic symptoms: a review

Molecular diagnosis of causality in T cell mediated severe cutaneous adverse drug reactions

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