First case of <scp>DRESS</scp> syndrome caused by hydroxychloroquine with a positive patch test

Jiménez, Araceli Castro; Navarrete, Nuria Navarrete; Gómez, Alejandro Raúl Gratacós; López, Fernando Florido; Rodríguez, Raúl Rodríguez; Torrijos, Elisa Gómez

doi:10.1111/cod.13657

Cited by 10 publications

(13 citation statements)

References 6 publications

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“…A total of 26 articles reporting cases related to the safety of HCQ or CQ during treatment for COVID-19 were found [ 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 ]. Table 6 synthesises the data from the cases reporting HCQ and CQ adverse drug reactions in COVID-19-affected patients and Table S21 of Supplementary Material part 2 provides full details.…”

Section: Resultsmentioning

confidence: 99%

“…A smaller number of cases were reported in patients treated with CQ for autoimmune conditions or malaria although one fatal case was reported [ 27 , 28 , 29 , 30 , 32 , 33 , 37 , 39 , 49 , 54 , 58 , 61 ]. In connection with treatment for COVID-19, 12 cases were reported in patients treated with HCQ including cases of psoriasis exacerbation, rash, acute generalised exanthematous pustulosis (AGEP), drug rash with eosinophilia and systemic symptoms (DRESS), urticaria, palmoplantar itching, and purpuric erythematous rashes [ 185 , 187 , 196 , 197 , 198 , 199 , 200 , 201 , 202 ].…”

Section: Resultsmentioning

confidence: 99%

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Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

et al. 2022

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Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

et al. 2022

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“…Fondaparinux appears to be tolerated by patients with previous delayed local reactions to LMWHs. [9][10][11][12] Systemic severe delayed reactions, particularly DRESS, are more rare. To our knowledge, this is the second report of a DRESS associated to exposure to enoxaparin and the rst one of DRESS associated to fondaparinux.…”

Section: Discussionmentioning

confidence: 99%

Sustained Drug-related Reaction With Eosinophilia and Systemic Symptoms (DRESS) Triggered by Low Molecular Weight Heparins in COVID-19: Management and Precision Diagnosis.

Minenna

Chaoul

Rossi

et al. 2021

Preprint

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Background. Low molecular weight heparins (LMWHs) are administered routinely to COVID-19 patients. Systemic reactions to LMWHs (both IgE-mediated and non IgE-mediated) are considered rare. Particularly, a single case of drug-related reaction with eosinophilia and systemic symptoms (DRESS) due to enoxaparin has been described in the literature. Here, we report on the first case of DRESS related to administration of fondaparinux.Case presentation. An elderly woman was diagnosed with COVID-19, during the “first wave” of the pandemics in Italy, and treated with enoxaparin (for anti-coagulation). A DRESS syndrome developed after two weeks (RegiSCAR score = 7). Enoxaparin was considered the culprit drug and replaced with the fully synthetic LMWH fondaparinux. At the same time, high-dosage prednisone was added to the therapy. The DRESS slowly subsided and the patient survived. Upon recovery and corticosteroid washout, a lymphocyte proliferation test for both LMWHs was performed, yielding a positive response not only for enoxaparin but also for fondaparinux. Conclusions. By lymphocyte proliferation test we demonstrated that both enoxaparin and fondaparinux were implicated in this case of DRESS, occurring in an elderly COVID-19 patient. In retrospect, the choice of using a sustained high-dose corticosteroid treatment while maintaining anti-coagulation by fondaparinux proved to be right. Ultimately, the patient recovered from both DRESS and COVID-19.

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“…She had been previously treated with hydroxychloroquine for suspected COVID-19. Later, a positive patch test concluded HCQ was the primary cause of DRESS in the patient [18]. The second case report presented a rare case of hydroxychloroquineinduced Stevens-Johnson syndrome (SJS) of a 42-year-old woman.…”

Section: Hydroxychloroquinementioning

confidence: 99%

Safety profile of COVID-19 drugs in a real clinical setting

Chiu

Bhardwaj

Sah

2022

Eur J Clin Pharmacol

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Purpose The coronavirus disease 2019 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has affected millions all over the world and has been declared pandemic, as of 11 March 2020. In addition to the ongoing research and development of vaccines, there is still a dire need for safe and effective drugs for the control and treatment against the SARS-CoV-2 virus infection. Numerous repurposed drugs are under clinical investigations whose reported adverse events can raise worries about their safety. The aim of this review is to illuminate the associated adverse events related to the drugs used in a real COVID-19 setting along with their relevant mechanism(s). Method Through a literature search conducted on PubMed and Google Scholar database, various adverse events suspected to be induced by eight drugs, including dexamethasone, hydroxychloroquine, chloroquine, remdesivir, favipiravir, lopinavir/ ritonavir, ivermectin, and tocilizumab, administered in COVID-19 patients in clinical practice and studies were identified in 30 case reports, 3 case series, and 10 randomized clinical trials. Results Mild, moderate, or severe adverse events of numerous repurposed and investigational drugs caused by various factors and mechanisms were observed. Gastrointestinal side effects such as nausea, abdominal cramps, diarrhea, and vomiting were the most frequently followed by cardiovascular, cutaneous, and hepatic adverse events. Few other rare adverse drug reactions were also observed. ConclusionIn light of their ineffectiveness against COVID-19 as evident in large clinical studies, drugs including hydroxychloroquine, lopinavir/ritonavir, and ivermectin should neither be used routinely nor in clinical studies. While lack of sufficient data, it creates doubt regarding the reliability of chloroquine and favipiravir use in COVID-19 patients. Hence, these two drugs can only be used in clinical studies. In contrast, ample well-conducted studies have approved the use of remdesivir, tocilizumab, and dexamethasone under certain conditions in COVID-19 patients. Consequently, it is significant to establish a strong surveillance system in order to monitor the proper safety and toxicity profile of the potential anti-COVID-19 drugs with good clinical outcomes.

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First case of DRESS syndrome caused by hydroxychloroquine with a positive patch test

Cited by 10 publications

References 6 publications

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

Sustained Drug-related Reaction With Eosinophilia and Systemic Symptoms (DRESS) Triggered by Low Molecular Weight Heparins in COVID-19: Management and Precision Diagnosis.

Safety profile of COVID-19 drugs in a real clinical setting

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