Leflunomide-induced DRESS syndrome with renal involvement and vasculitis

Pinto, Benzeeta; Dhir, Varun; Krishnan, Sabari; Nada, Ritambhra

doi:10.1007/s10067-012-2152-8

Cited by 21 publications

(15 citation statements)

References 17 publications

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“…Antibiotics-beta-lactams, sulfonamides, minocycline, ciprofloxacin [12], nitrofurantoin [13], azithromycin, linezolid [14] Antituberculosis medications-rifampin, amikacin [15,16] Proton pump inhibitors [17] Immunomodulators-cyclosporine, lenalidomide [18], leflunomide [19], dapsone, pentoxyphylline [20], sulfasalazine…”

Section: Risk Factorsmentioning

confidence: 99%

Eosinophilic Drug Allergy

Kuruvilla

Khan

2015

Clinic Rev Allerg Immunol

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While peripheral or tissue eosinophilia may certainly characterize drug eruptions, this feature is hardly pathognomonic for a medication-induced etiology. While delayed drug hypersensitivity reactions with prominent eosinophilic recruitment have been typically classified as type IVb reactions, their pathophysiology is now known to be more complex. Eosinophilic drug reactions have a diversity of presentations and may be benign and self-limited to severe and life-threatening. The extent of clinical involvement is also heterogeneous, ranging from isolated peripheral eosinophilia or single organ involvement (most often the skin and lung) to systemic disease affecting multiple organs, classically exemplified by drug-reaction with eosinophilia and systemic symptoms (DRESS). The spectrum of implicated medications in the causation of DRESS is ever expanding, and multiple factors including drug metabolites, specific HLA alleles, herpes viruses, and immune system activation have been implicated in pathogenesis. Due to this complex interplay of various factors, diagnostic workup in terms of skin and laboratory testing has not been validated. Similarly, the lack of controlled trials limits treatment options. This review also describes other localized as well as systemic manifestations of eosinophilic disease induced by various medication classes, including their individual pathophysiology, diagnosis, and management. Given the multitude of clinical patterns associated with eosinophilic drug allergy, the diagnosis can be challenging. Considerable deficits in our knowledge of these presentations remain, but the potential for severe reactions should be borne in mind in order to facilitate diagnosis and institute appropriate management.

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Section: Risk Factorsmentioning

confidence: 99%

Eosinophilic Drug Allergy

Kuruvilla

Khan

2015

Clinic Rev Allerg Immunol

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“…13 While the liver is the most commonly implicated organ, kidney involvement has been reported in the form of acute tubulointerstitial nephritis with sulfasalazine and leflunomide. 14,15 Though the specific mechanistic link to renal failure is not clear, a recent study examining peripheral T-cell responses in 40 patients with DRESS found that a majority of cases involved human herpesvirus 6, human herpesvirus 7, and Epstein-Barr virus reactivation. 16 …”

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confidence: 99%

Drug-induced impairment of renal function

Pazhayattil¹,

Shirali²

2014

IJNRD

117

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Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. However, all agents also carry adverse drug effect profiles. While most of these are clinically insignificant, some drugs may cause unacceptable toxicity that impacts negatively on patient morbidity and mortality. Recognizing adverse effects is important for administering appropriate drug doses, instituting preventive strategies, and withdrawing the offending agent due to toxicity. In the present article, we will review those drugs that are associated with impaired renal function. By focusing on pharmaceutical agents that are currently in clinical practice, we will provide an overview of nephrotoxic drugs that a treating physician is most likely to encounter. In doing so, we will summarize risk factors for nephrotoxicity, describe clinical manifestations, and address preventive and treatment strategies.

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“…To our knowledge, there have been very few cases that have been presented similarly. [6][7][8] We believe that further investigation is required to explore the association between leflunomide and DRESS, so as to allow safe prescription and education of patients who require leflunomide.…”

Section: Discussionmentioning

confidence: 99%

An Uncommon Presentation of DRESS Syndrome Secondary to Leflunomide Use: A Case Report

Rao

Sunkara

Srivastava

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a constellation of symptoms that manifest as a result of certain medications. Several antipsychotics, antibiotics, and sulfa-containing drugs are known to be implicated in the etiology of DRESS syndrome. The clinical presentation of this disorder consists of a diffuse rash, lymphadenopathy, and systemic organ damage. Our patient presented with symptoms consistent with DRESS syndrome after being started on leflunomide, which is not commonly associated with DRESS. The diagnostic workup comprised of monitoring inflammatory markers on laboratory work, an excisional lymph node biopsy (to rule out malignancy), and a skin biopsy (to assess the etiology of the rash). Our patient received systemic steroids, dose-adjusted based on expert opinion. Further research is required to explore the association between leflunomide and DRESS and address guidelines for the management of DRESS.

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Leflunomide-induced DRESS syndrome with renal involvement and vasculitis

Cited by 21 publications

References 17 publications

Eosinophilic Drug Allergy

Eosinophilic Drug Allergy

Drug-induced impairment of renal function

An Uncommon Presentation of DRESS Syndrome Secondary to Leflunomide Use: A Case Report

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