Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand

Abstract

DRESS is associated with severe morbidity and mortality. Phenytoin, nevirapine, allopurinol, and cotrimoxazole were the major causes. Allopurinol-induced DRESS had the longest onset time, and was associated with higher eosinophilia and incidence of renal involvement. Raising awareness among both health care providers and public for early detection and withdrawal of the causative agent is critical to save life and reduce morbidity.

Genetic Diversity of HLA Class I and Class II Alleles in Thai Populations: Contribution to Genotype-Guided Therapeutics

“…The onset of DRESS is approximately 1-8 weeks after drug initiation with the mortality rate of approximately 10% (Criado et al, 2012). From 2004 to 2014, the King Chulalongkorn Memorial Hospital Thailand reported list of drugs that could cause DRESS in Thai patients, including PHT, nevirapine, allopurinol, cotrimoxazole, dapsone, CBZ, isoniazid, ciprofloxacin, clindamycin, dacomitinib, danazol, omeprazole, and sulfadiazine (Hiransuthikul et al, 2016). Abacavir is used for treatment of human immunodeficiency virus type I infection (Sukasem et al, 2014;White et al, 2014).…”

The Medication Risk of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis in Asians: The Major Drug Causality and Comparison With the US FDA Label

“…The low nevirapine‐induced SJS/TEN in Asian countries may be related to the frequency of nevirapine use in Asian countries. However, it has been reported that nevirapine can cause more cases of drug reaction with eosinophilia and systemic symptoms complex (DRESS) than SJS/TEN in Thailand . Clinicians still have to be aware of nevirapine‐induced DRESS in Asian populations.…”

Treatment of severe drug reactions by hemodialysis

“…In every published case series describing these rashes, systemic involvement was noted and mortality rates were high, specifically in TEN and Stevens-Johnson syndrome. 7,15 Howard et al 16 reported a similar situation involving a cancer patient receiving high-dose methotrexate that resulted in toxicity; the patient improved after hemodialysis. Generally, morbidity and fatality in cutaneous adverse diseases is not directly caused by the skin disease but by the complications of organ injury and sepsis, wherein skin denudation allowed microbial entry into the circulation.…”