Use of antiviral medications in drug reaction with eosinophilia and systemic symptoms (<scp>DRESS</scp>): A case of infantile <scp>DRESS</scp>

Chow, Maggie; Kim, David; Kamath, Sonia; Peng, David H.; Luu, Minnelly

doi:10.1111/pde.13408

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…Diagnostic criteria are based upon the combination of specific clinical characteristics and laboratory data . Reactivation of viruses such as Epstein‐Barr virus (EBV), human herpesvirus 6 (HHV‐6), and human herpesvirus 7 (HHV‐7) may play a role in stimulating the syndrome with coinciding drug administration …”

Section: Introductionmentioning

confidence: 99%

“…1 Reactivation of viruses such as Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), and human herpesvirus 7 (HHV-7) may play a role in stimulating the syndrome with coinciding drug administration. 2,3 This entity has been best characterized in adults and is predominately associated with aromatic antiepileptic drugs including phenytoin, phenobarbital, and carbamazepine. 4,5 Understanding of DRESS in children is based upon case reports and small case series.…”

Section: Introductionmentioning

confidence: 99%

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Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Oberlin

Rahnama‐Moghadam

Alomari

et al. 2019

Pediatric Dermatology

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Background Pediatric Drug reaction with eosinophilia and systemic symptoms (DRESS) is an uncommon disease that can be difficult to diagnose. This case series and literature review highlights the clinical features of pediatric DRESS and underscores the differential diagnoses, culprit medications, and need for clinical follow‐up to detect associated autoimmune sequelae. Objective To describe the clinical and laboratory features of pediatric DRESS, identify associated culprit medications, and discuss the natural history of disease. Methods Ten cases of pediatric DRESS were identified in the electronic medical record by searching the inpatient dermatology consultation list at Indiana University between 2013 and 2018. Clinical and laboratory data were collected including demographics, differential diagnoses, culprit medications, resolution of disease, and autoimmune sequelae. Results Pediatric patients with DRESS presented at a mean age of 11.5 years and demonstrated a mean time from drug initiation to onset of symptoms of 4 weeks. The most common inciting drugs included antibiotics (62.5%) followed by antiepileptics (37.5%). Rash and transaminitis resolved by 3 weeks, and 20% of patients, all female, developed autoimmune sequelae including Hashimoto's thyroiditis and an undifferentiated connective tissue disorder and occurred at an average of 14.5 weeks after diagnosis. Limitations This was a small retrospective study of an uncommon clinical diagnosis at a single institution. Conclusions Pediatric DRESS was most commonly caused by antibiotics which are being increasingly recognized in the literature as the predominant culprit medications. The development of autoimmune sequelae is a notable consequence that can present weeks after illness and may preferentially affect female patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Oberlin

Rahnama‐Moghadam

Alomari

et al. 2019

Pediatric Dermatology

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“…By computing overlaps of the top 1000 genes with the ‘GO gene sets’ (C5) in MSigDB, we found enrichments in genes related to transcription regulation, signaling, development, differentiation, morphogenesis, cell proliferation, and cell fate ( Supplementary Table 12b ), whereas by using the ‘curated gene sets’ (C2) in MSigDB, we found enrichment of PRC2 (EED, SUZ12) targets, as well as of genes possessing bivalent (H3K4me3 and H3K27me3) marks in their promoters ( Supplementary Table 12c ). Interestingly, UHRF1 was recently demonstrated to be essential for maintenance of bivalent chromatin domains and regulation of lineage specification in embryonic stem cells 40 , whereas, UHRF1 silencing was shown to lead to reduced proliferation and increased apoptosis in some types of cancer 41 – 43 .…”

Section: Resultsmentioning

confidence: 99%

Converging genetic and epigenetic drivers of paediatric acute lymphoblastic leukaemia identified by an information-theoretic analysis

et al. 2021

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In cancer, linking epigenetic alterations to drivers of transformation has been difficult, in part because DNA-methylation analyses must capture epigenetic variability, which is central to tumour heterogeneity and tumour plasticity. Here, by conducting a comprehensive analysis, based on information theory, of differences in methylation stochasticity in samples from patients with paediatric acute lymphoblastic leukaemia (ALL), we show that ALL epigenomes are stochastic, and marked by increased methylation entropy at specific regulatory regions and genes. By integrating data methylation and single-cell gene-expression data, we arrived at a relationship between methylation entropy and gene-expression variability, and found that epigenetic changes in ALL converge on a shared set of genes that overlap with genetic drivers involved in chromosomal translocations across the disease spectrum. Our findings suggest that an epigenetically driven gene- regulation network, with UHRF1 (ubiquitin-like with PHD and RING finger domains 1) as a central node, links genetic drivers and epigenetic mediators in ALL.

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“…IVIG have been reported to be useful in a few adults with DRESS and detrimental in others 100 . Due to the fact that there is a major herpes viral reactivation along with presence of life‐threatening signs, it has been proposed to administer antiviral medications (eg, ganciclovir) in combination with steroids with or without IVIG, but the efficacy is unclear 101 …”

Section: Management and Treatmentmentioning

confidence: 99%

“…100 Due to the fact that there is a major herpes viral reactivation along with presence of life-threatening signs, it has been proposed to administer antiviral medications (eg, ganciclovir) in combination with steroids with or without IVIG, but the efficacy is unclear. 101 The management of SJS/TEN in the acute phase should be multidisciplinary and includes symptomatic and supportive treatments, dermatologic care, targeted therapies such as systemic glucocorticoids, IVIG and cyclosporine, and mechanistic therapies. 2,88,89,102,103 A specific severity-of-illness model has been developed (Score of Toxic Epidermal Necrolysis-SCORTEN) and is the most frequently used scoring system to predict the prognosis of SJS/TEN and calculate the probability of mortality.…”

Section: Manag Ement and Tre Atmentmentioning

confidence: 99%

Delayed hypersensitivity to antiepileptic drugs in children

Mori

Blanca‐López

Caubet

et al. 2020

Pediatric Allergy Immunology

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Background: Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self-limited, and spontaneously resolve within days after drug discontinuation, sometime HR reactions to AEDs can be severe and life-threatening. Aim: This paper seeks to show examples on practical management of AED HRs in children starting from a review of what it is already known in literature. Results: Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications, and genetic factors. The diagnostic workup consists of in vivo (intradermal testing and patch testing) and in vitro tests [serological investigation to exclude the role of viral infection, lymphocyte transformation test (LTT), cytokine detection in ELISpot assays, and granulysin (Grl) in flow cytometry. Treatment is based on a prompt drug discontinuation and mainly on the use of glucocorticoids. Conclusion: Dealing with AED HRs is challenging. The primary goal in the diagnosis and management of HRs to AEDs should be trying to accurately identify the causal trigger and simultaneously identify a safe and effective alternative anticonvulsant. How to cite this article: Mori F, Blanca-Lopez N, Caubet J-C, et al. Delayed hypersensitivity to antiepileptic drugs in children.

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Use of antiviral medications in drug reaction with eosinophilia and systemic symptoms (DRESS): A case of infantile DRESS

Cited by 11 publications

References 12 publications

Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Converging genetic and epigenetic drivers of paediatric acute lymphoblastic leukaemia identified by an information-theoretic analysis

Delayed hypersensitivity to antiepileptic drugs in children

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