New Insights into Drug Reaction with Eosinophilia and Systemic Symptoms Pathophysiology

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome, is a severe type of cutaneous drug-induced eruption. DRESS may be a difficult disease to diagnose since the symptoms mimic those of cutaneous and systemic infectious pathologies and can appear up to 3 months after the initial culprit drug exposure. The symptoms of DRESS syndrome include rash development after a minimum of 3 weeks after the onset of a new medication, associated with facial edema, lymphadenopathy, and fever. Biological findings include liver abnormalities, leukocytosis, eosinophilia, atypical lymphocytosis, and reactivation of certain human herpes viruses. In DRESS, liver, kidneys, and lungs are frequently involved in disease evolution. Patients with serious systemic involvement are treated with oral corticosteroids, and full recovery is achieved in the majority of cases. DRESS is a rare disease, and little is known about factors that predict its occurrence. The key features of this reaction are eosinophil involvement, the role of the culprit drug, and virus reactivation that trigger an inappropriate systemic immune response in DRESS patients. Interestingly, it was evidenced that at-risk individuals within a genetically restricted population shared a particular HLA loci. In this respect, a limited number of well-known drugs were able to induce DRESS. This review describes the up-to-date advances in our understanding of the pathogenesis of DRESS.

Targeted therapy guided by single-cell transcriptomic analysis in drug-induced hypersensitivity syndrome: a case report

“…Thus, the diverse CD4 + T cell activation in response to SMX/TMP required TCR-MHC II engagement, suggesting an unconventional T cell activation process leading to activation of CD4 + T cells. This may be in line with previously suggested mechanism in drug hypersensitivities in which the culprit drug acts as a superantigen or modifies the MHC, resulting in its engagement with a wider range of TCRs 20 , 33 , 34 .…”

“…Contribution of herpesviruses to DiHS/DRESS pathogenesis remains controversial. However, virus reactivation occurs without immunosuppressive therapies and the emergence of virus-specific CD8 + T cells suggests that herpesvirus reactivation is an integral component of disease process 4 , 19 , 20 . Among herpesviruses, HHV6b reactivation is reported to occur in the majority of DiHS/DRESS cases 1 , 4 , 5 .…”

Severe DRESS syndrome after carbamazepine intake in a case with multiple addictions: A case report

“…This syndrome appears frequently after anticonvulsant therapy, usually after a period of up to 6 weeks following the beginning of the treatment and the possibility of worsening the symptoms after drug withdrawal (3,4). In addition, there are other drugs responsible for DRESS, such as nonsteroidal anti-inflammatory compounds, antidepressants and some antimicrobial substances (5,6).…”

62-Year-Old Man With Fever and Pruritic Rash

“…They act by binding antibody-bound cells and releasing the contents of cytotoxic granules, which is the mechanism by which eosinophils are thought to cause the organ damage in the heart, liver, and lungs seen in DRESS. 10 The most commonly implicated medications are anticonsultants (carbamazepine, lamotrigine, phenytoin, etc), antibacterial medications (amoxicillin, ampicillin, piperacillin/tazobactam, minocycline, etc), sulfonamides (such as sulfasalazine), and allopurinol. 11 Once DRESS syndrome has been diagnosed, treatment should focus on supportive therapies.…”