Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and the Rheumatologist

Abstract

The most commonly reported drugs are allopurinol, sulfasalazine and minocycline, which pose a very high risk for DRESS syndrome development, followed by strontium ranelate and dapsone. Other, less commonly reported, drugs include leflunomide, hydroxychloroquine, non-steroidal anti-inflammatory drugs, febuxostat, bosentan and solcitinib. Reaction to some drugs is strongly associated with certain HLA alleles, which may be used to screen patients at risk of serious toxicity. DRESS syndrome is a serious reaction to many drugs used in rheumatic diseases, with a potentially fatal outcome and needs to be considered in any patient started on these medications who presents with a rash, fever and eosinophilia, sometimes with internal organ involvement.

Unravelling cases of clozapine-related Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in patients reported otherwise: A systematic review

“…Eosinophilia within clozapine-related DRESS also merits some attention. Eosinophilia in DRESS related to other drugs varies largely (Adwan, 2017;Behera et al, 2018;Cacoub et al, 2011;Ghannam et al, 2017;Kardaun et al, 2013). In our sample, it was observed in around 60% of the patients.…”

Síndrome de DRESS inducido por sulfasalazina. ¿Consideramos esta reacción adversa grave al indicar el fármaco? Caso clínico

“…Aunque su etiopatogenia aún es desconocida, se han involucrado factores de predisposición genética, reactivación de infecciones virales 9,10 (principalmente virus herpes humano [VHH] 6 y 7, Epstein Barr y citomegalovirus [CMV]) y alteraciones en el metabolismo de fármacos, como acetilación lenta y defectos en la detoxificación que resultan en metabolitos reactivos capaces de desencadenar una respuesta inmune alterada 2 . Entre los fármacos clásicamente asociados a este síndrome se describen anticonvulsivantes (35%), alopurinol (18%), sulfas (12%) y antibióticos (11%) 8 (Tabla 1), aunque en estudios más recientes, los antibióticos ocupan el primer lugar (74%) 7 y, en una serie de pacientes reumatológicos, la sulfasalazina ocupó el segundo lugar luego del alopurinol 11 .…”

A Case Report of Fulminant Type 1 Diabetes Mellitus Caused by Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Complicated by Iodine-Induced Thyrotoxicosis

“…Typical DRESS patients would have been exposed to a high-risk medication [ 7 ]. A retrospective analysis of 45 patients with DRESS showed that the most common causative drug group was antibiotics (28.9%), followed by anticonvulsants (26.7%) [ 8 ].…”