Sulfasalazine Induced DRESS Syndrome: A Review of Case Reports

Jasmeen,; Krishan, Pawan; Varma, Sudhir; Kalra, Harpreet Singh; Vohra, Kanchan

doi:10.9734/bjmmr/2016/20558

Cited by 6 publications

(2 citation statements)

References 39 publications

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“…The second most often affected organ in sulfasalazine induced DRESS syndrome is the kidney, but although our patient had elevated serum creatinine and urea levels, we didn't classify it as renal involvement since estimated glomerular filtration rate, creatinine clearance and 24h proteinuria were normal. The cases of lung and cardiac dysfunction in sulfasalazine induced DRESS syndrome have also been described [7,16]. The authors did not notice any reports of other organ involvement such as central nervous system when reviewing the available literature on sulfasalazine induced DRESS syndrome.…”

Section: Discussionmentioning

confidence: 95%

“…Sulfasalazine was firstly synthesized in 1930 and is currently being prescribed for various inflammatory and rheumatic diseases because of its anti-inflammatory properties. A review article from 2016 conducted by Jas-meen et al registered nearly 50 independent case reports of sulfasalazine induced DRESS syndrome from 1990 to 2015, which diagnosis was made by the use of RegiSCAR scoring system [7]. The patient gave a written consent for the anonymous publication of this case report.…”

Section: Introductionmentioning

confidence: 99%

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Sulfasalazine Induced DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome with severe acute hepatitis: Case report

Kuzman,

Jeremić-Gajinov,

Vesković

et al. 2023

Hosp Pharm Int Multi J

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Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome is a rare and severe form of drug induced delayed-type hypersensitivity reaction with mortality rate up to 10%. It usually manifests with skin rash, fever, lymphadenopathy, hematological abnormalities and involvement of one or more internal organs. Establishing the diagnosis is sometimes late due to variable clinical presentation. Current recommendations for therapy rely mainly on expert opinions, retrospective studies, case reports and series. Sulfasalazine was firstly synthesized in 1930 and is currently being prescribed for various inflammatory and rheumatic diseases. Case report: We present a 45-year-old patient who was prescribed sulfasalazine tablets by a rheumatologist due to reactive arthritis. In the fourth week of therapy, he developed skin rash and fever up to 39.5°C. On admission, generalized maculopapular exanthema covering over 60% of the body surface area, edema of the lower eyelids and bilateral cervical and inguinal lymphadenomegaly were registered. Laboratory findings showed leukocytosis with significant eosinophilia, lymphocytosis, elevated bilirubin values, ALT <100 U/L, while ultrasonography of the upper abdomen confirmed hepatosplenomegaly. The patient was diagnosed with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome using RegiSCAR and J-SCAR diagnostic criteria and systemic therapy with methylprednisolone at a dose of 1.5 mg/kg and other supportive therapy was applied, which resulted in complete regression of the skin changes and normalization of laboratory values. Conclusion: The authors would like to recall the occurrence of Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome as a rare and potentially fatal drug reaction in which awareness of this disease is of key importance for early recognition. Identification of the offending drug followed by a prompt withdrawal and subsequent treatment is essential for decreasing disease related morbidity and mortality and thus we wish to familiarize the sulfasalazine prescribers with this syndrome.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Sulfasalazine Induced DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome with severe acute hepatitis: Case report

Kuzman,

Jeremić-Gajinov,

Vesković

et al. 2023

Hosp Pharm Int Multi J

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DRESS syndrome without eosinophilia presented with extensive skin rash and acute respiratory failure

Chaisrimaneepan,

Pruneda,

Elmassry

et al. 2024

Clinical Case Reports

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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and the Rheumatologist

Adwan

2017

Curr Rheumatol Rep

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The most commonly reported drugs are allopurinol, sulfasalazine and minocycline, which pose a very high risk for DRESS syndrome development, followed by strontium ranelate and dapsone. Other, less commonly reported, drugs include leflunomide, hydroxychloroquine, non-steroidal anti-inflammatory drugs, febuxostat, bosentan and solcitinib. Reaction to some drugs is strongly associated with certain HLA alleles, which may be used to screen patients at risk of serious toxicity. DRESS syndrome is a serious reaction to many drugs used in rheumatic diseases, with a potentially fatal outcome and needs to be considered in any patient started on these medications who presents with a rash, fever and eosinophilia, sometimes with internal organ involvement.

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Sulfasalazine Induced DRESS Syndrome: A Review of Case Reports

Cited by 6 publications

References 39 publications

Sulfasalazine Induced DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome with severe acute hepatitis: Case report

Sulfasalazine Induced DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome with severe acute hepatitis: Case report

DRESS syndrome without eosinophilia presented with extensive skin rash and acute respiratory failure

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and the Rheumatologist

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