Dress syndrome with sepsis, acute respiratory distress syndrome and pneumomediastinum

Abstract

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome reflects a serious hypersensitivity reaction to drugs, and is characterized by skin rash, fever, lymph node enlargement, and internal organ involvement. So far, numerous drugs such as sulfonamides, phenobarbital, sulfasalazine, carbamazepine, and phenytoin have been reported to cause DRESS syndrome. We report a case of a 10-year-old girl who developed clinical manifestations of fever, rash, lymphadenopathy, hypereosinophilia, and visceral involvement (hepatitis and pneumonitis) after taking phenobarbital for seizures, with subsequent development of sepsis, acute respiratory distress syndrome (ARDS) and spontaneous air leak syndrome (pnemothorax and pneumomediastinum). She was put on steroids and various antibiotics and was ventilated, but ultimately succumbed to sepsis and pulmonary complications.

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms severity score: A useful tool for assessing disease severity and predicting fatal cytomegalovirus disease

“…Complications occurring during DiHS/DRESS have been extensively described in previous studies [5][6][7][8][9][10][11][12][13][14] and have received attention as the cause of mortality in DiHS/DRESS. These complications include myocarditis, Pneumocystis jirovecii pneumonia, sepsis, and gastrointestinal bleeding, 5-14 most of which lead to significant morbidity and mortality if unrecognized and untreated.…”

“…These complications include myocarditis, Pneumocystis jirovecii pneumonia, sepsis, and gastrointestinal bleeding, 5-14 most of which lead to significant morbidity and mortality if unrecognized and untreated. [5][6][7]10,12,13 Therefore, the establishment of a scoring system using routinely obtained parameters by which disease severity and treatment efficacy can be assessed at any time and disease progression to more aggressive stage can be predicted is urgently needed for the successful management of DiHS/DRESS. By comparing the composite score in the early phase (days 0-3) with that at any time after starting therapy, the composite score can provide clinicians with clues for optimizing therapeutic efficacy and preventing treatmentrelated relapse.…”

“…In view of our finding that CMV reactivation occurred 27.2 6 2.3 days after onset while complications developed 33.2 6 6.2 days after onset in CMV 1 cases, most late-onset complications would be caused by CMV reactivation. Because previous studies indicated that CMV reactivation could be the cause of several complications, such as gastrointestinal bleeding, 5,14 renal dysfunction, 7 myocarditis, 10 and sepsis, 12,13 it is likely that fatal complications occurring in the late stage of DiHS/DRESS could be preventable with anti-CMV therapy. In support of this possibility, a delay in initiating anti-CMV therapy after the first detection of CMV reactivation was likely to reduce efficacy; cessation of anti-CMV therapy was temporarily associated with the development of CMV disease or complications, as shown in case 5.…”

“…Various clinical symptoms and fatal complications that have traditionally been regarded as being either related or unrelated to severe drug eruptions or CMV reactivation may develop at various time points after onset, indicating difficulties to predict its prognosis. [1][2][3]6 Because these complications have been underrecognized and are often fatal if not promptly treated, [5][6][7][8][9][10][11][12][13][14][15] there is a clear need to identify effective parameters for assessing disease severity and predicting prognosis of the disease in the early stage.…”

Phenytoin Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

“…DRESS, if recognized before signifi cant visceral involvement along with prompt withdrawal of off ending drug, is associated with be er prognosis. As liver failure is the most common cause of fatali es associated with DRESS 8 , liver func on tests should be closely monitored in these pa ents. The fi rst line treatment for DRESS is systemic cor costeroids.…”