Drug reaction with eosinophilia and systemic symptoms (DRESS): a retrospective analysis of 21 cases in a tertiary teaching hospital in Hong Kong.

Abstract

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) is an acute, distinct and severe idiosyncratic reaction with a mortality of 8% to 10%. Owing to the rarity of the syndrome, large-scale studies are limited. Important data including the pattern of etiological agents, clinical and biochemical features and prognosis are lacking. OBJECTIVE: To investigate the demographic data, clinical and biochemical characteristics, causative agents, treatment, and outcome of cases of DRESS in Hong Kong. METHODS: A single center retrospective study on 21 cases of DRESS from February 2007 to February 2011. Medical records, clinical photographs, and sequential laboratory data were reviewed. An attempt was made to identify any correlation among the clinical pattern and specific causative agents. MAIN OUTCOME MEASURES: Clinical and biochemical pattern for specific drugs, treatment outcome and prognosis of DRESS. RESULTS: Age of onset ranged from 14 to 77. No sex predilection was observed. The most common offending drug was allopurinol (28.6%), followed by phenobarbitone and trimethoprim-sulfamethoxazole. Mean latency period was 21.6 days. Exanthematous eruption was the most common cutaneous manifestation. Fever, hepatitis and eosinophilia were present in all cases. Renal impairment was observed in 7 patients (33.3%). Allopurinol-induced DRESS was associated with a higher frequency of preexisting renal insufficiency (P = .02) and increased risk of renal involvement as part of the syndrome (P = .002). Lichenoid dermatitis was the most common histopathologic feature. Systemic corticosteroid was commenced in 15 cases (71.4%). The average initial dose was 54.6 mg/day (0.95 mg/kg/day). The mean duration of corticosteroid use was 33 weeks. Steroid-sparing agents were used in 7 cases. Two cases in the case series developed autoimmune thyroiditis and one case developed bronchiolitis obliterans organizing pneumonia on subsequent follow-ups. The overall mortality was 4.8%. Prolonged erythroderma were observed in 2 cases induced by trimethoprim-sulfamethoxazole. CONCLUSION: DRESS is a form of severe cutaneous adverse reaction and associated with a variety of clinical and biochemical features. Allopurinol is a common causative agent of DRESS and its use in patients with pre-existing renal insufficiency should be cautiously monitored. Copyright © 2012 Published by Mosby, Inc.