Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System

Cho, Yung-Tsu; Yang, Chen; Chu, Chia-Yu

doi:10.3390/ijms18061243

Cited by 212 publications

(378 citation statements)

References 126 publications

Supporting

Mentioning

321

Contrasting

Unclassified

Order By: Relevance

“…Hundreds of drugs are implicated in isolated liver injury or skin injury. Remarkably, only a limited number of drugs are associated with concomitant liver and skin injury . The exact reason, why a small subset of people exposed to a drug develop SCAR and liver injury and a vast majority do not, is not clear.…”

Section: Drugs Associated With Disi and Dilimentioning

confidence: 99%

See 1 more Smart Citation

Drug‐induced liver injury with skin reactions: Drugs and host risk factors, clinical phenotypes and prognosis

Devarbhavi

Raj

2018

Liver International

View full text Add to dashboard Cite

While dermatologic manifestations of adverse drug reactions are frequent, drug‐induced liver injury is rare. Numerous drugs are implicated in either Drug‐Induced Liver Injury or Drug‐Induced Skin Injury. However, concomitant Drug‐Induced Liver Injury and Drug‐Induced Skin Injury are uncommon, not well characterized and appear to be caused by a limited number of drugs. These are often associated with immuno‐allergic or hypersensitivity features such as fever, skin rash, blisters or peeling of skin, eosinophilia, lymphadenopathy and mucositis. Liver injury can range from asymptomatic elevation of liver biochemical tests to severe hepatitis and acute liver failure needing liver transplantation. Severe cutaneous adverse reaction, particularly drug reaction with eosinophilia and systemic symptoms is commonly associated with internal organ involvement, the liver being the most frequently involved in approximately 90% of the cases. In Stevens‐Johnson Syndrome/Toxic Epidermal Necrolysis, abnormalities in liver biochemistry tests are common but severe liver disease is rare. There is a strong association of Human Leukocyte Antigen genotype with both drug reaction with eosinophilia and systemic symptoms and Stevens‐Johnson Syndrome/Toxic Epidermal Necrolysis. It is likely that the delayed immune‐mediated reaction triggering skin reaction is also responsible for hepatitis. Drug‐specific lymphocytes are found in the organs involved and also in circulating blood, which along with the cytokines and chemokines play a role in pathogenesis. Anti‐epileptic drugs, allopurinol, sulfonamides, antibiotics and nevirapine are the top five causes of concomitant liver and skin injury. This review will focus on drug and host factors causing concomitant Drug‐Induced Skin Injury and Drug‐Induced Liver Injury and discuss the characteristics of liver involvement in patients with severe cutaneous adverse reaction.

show abstract

Section: Drugs Associated With Disi and Dilimentioning

confidence: 99%

“…In the prospective RegiSCAR study, AED's were involved in 35%, followed by allopurinol in 18%, antimicrobial sulfonamides and dapsone in 12% and other antibiotics in 11% . The median time interval from drug intake was 3‐8 weeks . However, medications associated with concomitant DILI and DISI are rare.…”

Section: Drugs Associated With Disi and Dilimentioning

confidence: 99%

Drug‐induced liver injury with skin reactions: Drugs and host risk factors, clinical phenotypes and prognosis

Devarbhavi

Raj

2018

Liver International

View full text Add to dashboard Cite

show abstract

“…Facial edema is also a common feature of the disease [5]. Elevation of liver function tests occurs in a majority of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…The frequency has been estimated to be 1 in 1000 to 1 in 10,000 drug exposures [5,6] A key feature is the delayed onset most often between 2 and 6 weeks after the drug was initiated. This helps to distinguish this drug reaction from others (i.e., SJS/TEN -3 days to 3 weeks; acute generalized exanthematous pustulosis -2 to 3 days) [8].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple case reports have stated that starting the patient on a ketogenic diet as soon as possible is the most effective treatment [5]. Anakinra is a recombinant version of the human interleukin-1 receptor antagonist used to treat auto-inflammatory disorders in neonates and children, and has shown powerful anticonvulsant properties in animal models [6].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

DRESS following FIRES: A Clinical Conundrum

Dahl¹,

Knoebel²,

Lloyd³

2018

Clin Pediatr OA

View full text Add to dashboard Cite

A previously healthy 2-year old Hmong girl presented to the Emergency Department with first time seizures during a febrile illness. Seizures continued for the next two weeks despite multiple antiepileptic agents. All initial cultures and evaluations were negative, and febrile infection related epilepsy syndrome (FIRES) was diagnosed.Three weeks into her hospital course, the patient developed a morbilliform rash on her thigh that became generalized. Concurrently, she developed fever and tachycardia. Laboratory studies demonstrated eosinophilia, an increase in ALT, AST, and direct/total bilirubin. CMV, EBV, and HHV-6 were negative. Skin biopsy showed lichenoid interface dermatitis. Clinical picture was suggestive of drug reaction with eosinophilia and systemic symptoms (DRESS). Topical and systemic steroids were started. Potential triggers for DRESS were discontinued. The patient deteriorated and cardiorespiratory failure occurred. She required ECMO for eight days. Patient gradually improved over the following weeks despite recurrent seizures and remained in the hospital for 283 days. FIRES is a rare and highly morbid condition in which patients develop status epilepticus in the setting of febrile illness that is often intractable to anticonvulsants and steroids. Typically no causative infection is identified. DRESS, another rare and potentially fatal condition, is a drug hypersensitivity reaction that includes eosinophilia, characteristic skin findings and potential involvement of liver, lungs, kidneys, or other organs. Allopurinol, antiepileptic agents, and antibiotics are the most frequently reported triggers.In this case report, we describe a patient who developed DRESS following FIRES, a sequence not previously described in the literature.

show abstract

Human Herpesviruses 6A, 6B, and 7

Greninger,

Sedlak,

Jerome

2023

ClinMicroNow

View full text Add to dashboard Cite

Human herpesvirus (HHV) 6A, HHV‐6B, and HHV‐7 are three distinct virus species that make up the Roseolovirus genus. Like HHV‐6, HHV‐7 infection is highly prevalent and infects most individuals during childhood. HHV‐7 DNA has been detected more frequently and at higher loads in affected tissues from non‐immunocompromised patients with interstitial pneumonia. Interpreting HHV‐6 detection by PCR in clinical specimens is complicated by both the ubiquity of subclinical reactivation and inherited chromosomally integrated forms. HHV‐6A and HHV‐6B can be typed through the use of species‐specific monoclonal antibodies and species‐specific PCR assays. The most usual setting for HHV‐6 testing is in the context of immunosuppression, especially hematopoietic cell or solid organ transplantation. Like all herpesviruses, HHV‐7 establishes latency after primary infection, and thus reactivation can later occur, particularly in the setting of immunodeficiency. Cytomegalovirus viremia is also more frequent among recipients with inherited chromosomally integrated HHV‐6.

show abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System

Cited by 212 publications

References 126 publications

Drug‐induced liver injury with skin reactions: Drugs and host risk factors, clinical phenotypes and prognosis

Drug‐induced liver injury with skin reactions: Drugs and host risk factors, clinical phenotypes and prognosis

DRESS following FIRES: A Clinical Conundrum

Human Herpesviruses 6A, 6B, and 7

Contact Info

Product

Resources

About