Histopathological characterization of drug rash with eosinophilia and systemic symptoms (DRESS) and comparison with maculopapular drug rash (MPDR)

Jindal, Rashmi; Chugh, Robin; Chauhan, Payal; Shirazi, Nadia; Bisht, YashwantS

doi:10.4103/idoj.idoj_452_21

Cited by 5 publications

(11 citation statements)

References 11 publications

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“…Furthermore, the skin biopsy was consistent with severe drug reactions. Of note, the histopathology of DRESS has not been well specified and is typically labeled as “EM-like, spongiotic, lichenoid, or toxic epidermal necrolysis-like” [ 5 ]. The combination of BRAF and mitogen-activated protein kinase kinase (MEK) inhibitors has become the standard of care in metastatic melanomas with the BRAFV600E mutation.…”

Section: Discussionmentioning

confidence: 99%

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Vemurafenib- and Cobimetinib-Associated Drug Reaction With Eosinophilia and Systemic Symptoms in a Patient With Metastatic Melanoma

Al-Saedy,

Rieck

2023

Cureus

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction associated with drug exposure. Recognizing signs of DRESS and stopping the offending agent is essential for proper treatment. In this case report, we present an interesting case of DRESS following the recent initiation of vemurafenib and cobimetinib for the treatment of metastatic melanoma in a patient who previously had been on pembrolizumab without adverse skin reactions. In this case report, we highlight the ambiguity of using the Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) scoring criteria in the hospital setting for recognizing DRESS in patients with toxic epidermal necrolysis (TEN)-type presentation of DRESS.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, the skin biopsy was consistent with severe drug reactions. Of note, the histopathology of DRESS has not been well specified and is typically labeled as "EM-like, spongiotic, lichenoid, or toxic epidermal necrolysis-like" [5].…”

Section: Discussionmentioning

confidence: 99%

Vemurafenib- and Cobimetinib-Associated Drug Reaction With Eosinophilia and Systemic Symptoms in a Patient With Metastatic Melanoma

Al-Saedy,

Rieck

2023

Cureus

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“…At the same time, investigations were conducted to exclude concomitant viral or bacterial infections, which were negative. Based on the patient's histological examination and clinical presentation, with suspicion of drug reaction syndrome with eosinophilia and systemic symptoms (DRESS), the RegiSCAR score [10][11][12] was calculated, which further strengthened the suspicion (fever >38.5°C, eosinophilia >20%, lymphopenia, itchy skin rash, generalized edema, other causes ruled out, no ongoing infection, RegiSCAR score: 6). It should be noted that in our patient there was no evidence of visceral or mucosal involvement, although no drugs had been introduced recently and the only noteworthy information was a trip abroad; the patient did not report any recent exogenous substance intake.…”

Section: Case Reportmentioning

confidence: 99%

DRESS syndrome in a patient undergoing stem cell transplantation: Can sirolimus be involved?

Cassalia,

Spiller,

Salmaso

et al. 2023

Clinical Case Reports

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We present a case of sirolimus‐induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a stem cell transplant patient. Sirolimus is an immunosuppressive drug that inhibits the mammalian target of rapamycin (mTOR) pathway. A 24‐year‐old male with a history of acute lymphoblastic leukemia (ALL) underwent testicular extraction followed by hematopoietic stem cell transplantation (HSCT). He presented with pruritic eczematous lesions, which were initially treated with topical steroids. However, he later developed diffuse xerosis, fever, chills, generalized edema, weight gain, eosinophilia, and leukopenia. Skin biopsy showed spongiotic dermatitis with eosinophils, suggesting a drug or atopic reaction. Investigations ruled out infections, and the RegiSCAR score indicated drug reaction syndrome with eosinophilia and systemic symptoms (DRESS). Sirolimus, an immunosuppressive drug, was suspected as the cause. Sirolimus was discontinued, and oral steroids were initiated. After 3 weeks of therapy, the patient showed improvement with resolution of symptoms. Although no cases of sirolimus‐induced DRESS syndrome have been reported, allergic reactions with eosinophilia induced by everolimus have been documented. In our case, the patient's history characterized by stem cell transplantation and multiple immunosuppressive therapies may have contributed to the development of DRESS syndrome after beginning sirolimus therapy. This case may be the first evidence of sirolimus‐induced DRESS syndrome in a stem cell transplant patient.

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“…1 Clinical presentation includes exfoliation (scaling/desquamation), facial edema, purpura, and mucosal involvement. 2,3…”

Section: Introductionmentioning

confidence: 99%

Histopathologic Features of Drug Reaction With Eosinophilia and Systemic Symptoms

Ehsan,

Wei,

Georgesen

2024

The American Journal of Dermatopathology

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Importance: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous adverse reaction occurring 2 to 8 weeks after medication initiation. Diagnosis is clinical; RegiSCAR scoring includes biopsy “suggestive of DRESS,” undefined in the literature. Objective: This study correlates DRESS dermatopathology, culprit drugs, disease course, and outcome severity compared with maculopapular drug reactions (MDR). Methods: Between 2014 and 2023, a retrospective cohort study at a tertiary care institute reviewed 55 patients with DRESS, assessing demographics, culprit drug, illness course, and histopathology. Biopsies of 15 patients with DRESS and 15 MDR patients were graded by a predefined histopathological scoring system. Statistical analysis (significant P-value<0.05) included the Fisher exact probability, ANOVA, and correlation tests. Results: Among 55 patients with DRESS (mean age 50.13, 28 female/27 male), 15 (mean age 50.4, 7 female/8 male) had diagnostic biopsies. Compared with MDR patients, patients with DRESS exhibited significantly more interface dermatitis (P = 0.04), lichenoid dermatitis (P = 0.0007), pigment incontinence (P = 0.04), and periadnexal interface dermatitis (P = 0.002). MDR biopsies displayed perivascular inflammation and higher eosinophils than DRESS, trending toward significance. Conclusions: Key histopathologic features are interface dermatitis, periadnexal interface dermatitis, lichenoid dermatitis, pigment incontinence, and neutrophils dominance over eosinophils indicate DRESS clinically.

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Histopathological characterization of drug rash with eosinophilia and systemic symptoms (DRESS) and comparison with maculopapular drug rash (MPDR)

Cited by 5 publications

References 11 publications

Vemurafenib- and Cobimetinib-Associated Drug Reaction With Eosinophilia and Systemic Symptoms in a Patient With Metastatic Melanoma

Vemurafenib- and Cobimetinib-Associated Drug Reaction With Eosinophilia and Systemic Symptoms in a Patient With Metastatic Melanoma

DRESS syndrome in a patient undergoing stem cell transplantation: Can sirolimus be involved?

Histopathologic Features of Drug Reaction With Eosinophilia and Systemic Symptoms

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