Liver involvement in the drug reaction, eosinophilia, and systemic symptoms syndrome

Abstract

First described in 1996, the drug reaction, eosinophilia, and systemic symptoms syndrome (DReSS) is considered, along with Stevens-Johnson syndrome and toxic epidermal necrolysis, a severe cutaneous drug reaction. It is characterized by the presence of a maculopapular erythematous skin eruption, fever, lymphadenopathy, influenza-like symptoms, eosinophilia, and visceral involvement such as hepatitis, pneumonitis, myocarditis, pericarditis, nephritis, and colitis. The prognosis of patients with DReSS is related to the severity of visceral involvement. The mortality ranges from approximately 5% to 10%, and death is mainly due to liver failure, which is also the organ most commonly involved in this syndrome. Although it was previously hypothesized in 1994, DReSS syndrome can lead to reactivation of one or more human herpesvirus family members. Now being included as diagnostic criteria in a proposed diagnostic score system, this reactivation can be detected up to 2-3 wk after DReSS syndrome onset. Other causes of mortality in DReSS syndrome include myocardial or pulmonary lesions and hemophagocytosis. We reviewed the literature of previously reported case-series of DReSS and liver involvement, highlighting the pattern of liver damage, the treatment used, and the outcome.

Hepatic manifestations of drug reaction with eosinophilia and systemic symptoms syndrome

“…The liver is the most frequently affected visceral organ in patients with DRESS syndrome [2,[8][9][10]. Hepatic involvement has been described in up to 75-95% of patients, which can range from a slight elevation of transaminases to liver failure, being associated with a mortality of around 10% [1,8,[11][12][13][14]. It has been postulated that the clinical features may be related to the class of drug taken [7].…”

Systematic review: ibuprofen‐induced liver injury

“…These reactions are often allergic in nature, mostly mild, occur rapidly after drug exposure and rarely contain hepatic involvement. In contrast, DRESS syndrome often presents with concurrent cutaneous and hepatic reactions . However, ibuprofen does not appear to be a major cause of DRESS (with liver involvement) as we only identified one case in our literature search.…”

“…In contrast, DRESS syndrome often presents with concurrent cutaneous and hepatic reactions. 46 However, ibuprofen does not appear to be a major cause of DRESS (with liver involvement) as we only identified one case in our literature search.…”

Trimethoprim‐induced drug reaction with eosinophilia and systemic symptoms (DRESS) associated with reactivation of human herpes virus‐6 (HHV‐6) leading to acute liver failure

“…The mortality rate is estimated to be between 5% to −10%. 13,14 The development of autoimmune conditions, particularly thyroid disease, but also diabetes mellitus, and alopecia areata following an episode of DRESS are well-described. Patients should have thyroid function assessed 4-6 weeks postrecovery, and at 6 months, or when symptoms suggestive of thyroid dysfunction present.…”

“…Most cases of DRESS have been reported in adults with an incidence of 1 in 1000 to 1 in 10 000 drug exposures. The mortality rate is estimated to be between 5% to −10% 13,14 . The development of autoimmune conditions, particularly thyroid disease, but also diabetes mellitus, and alopecia areata following an episode of DRESS are well‐described.…”