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Robin Klein - One of the best experts on this subject based on the ideXlab platform.
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Successful Treatment of Sulfasalazine‐Induced DRESS Syndrome with Corticosteroids and N‐Acetylcysteine
Pharmacotherapy, 2011Co-Authors: Joyce Jose, Robin KleinAbstract:Drug rash with eosinophilia and systemic symptoms (DRESS) Syndrome is a rare, severe drug hypersensitivity Syndrome characterized by fever, rash, hematologic abnormalities, and systemic involvement. The pathogenesis of DRESS is unclear, but it is thought that the offending drug induces an immunemediated hypersensitivity reaction through defects in metabolism. Severe cases of DRESS often require aggressive treatment; however, current pharmacologic treatment options are limited. We describe a 66-year-old woman who presented with fever and rash 3 weeks after starting sulfasalazine treatment for rheumatoid arthritis. Investigation revealed diffuse lymphadenopathy, leukocytosis, eosinophilia, and hepatitis. She was diagnosed with DRESS Syndrome, sulfasalazine was discontinued, and she was treated with methylprednisolone. Her condition deteriorated, and she developed severe acute liver failure prompting evaluation for liver transplantation. Corticosteroid treatment was escalated to high-dose methylprednisolone, and N-acetylcysteine was started, which prompted improvement in her symptoms and liver function. To our knowledge, this is the first case report to describe the safe and successful use of corticosteroids and N-acetylcysteine to treat sulfasalazine-induced DRESS Syndrome. Given the potential morbidity and mortality of DRESS Syndrome, effective treatment alternatives for severe cases are needed. N-Acetylcysteine may be a safe adjunct to corticosteroid therapy for severe cases of sulfasalazine-induced DRESS Syndrome.
Joyce Jose - One of the best experts on this subject based on the ideXlab platform.
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Successful Treatment of Sulfasalazine‐Induced DRESS Syndrome with Corticosteroids and N‐Acetylcysteine
Pharmacotherapy, 2011Co-Authors: Joyce Jose, Robin KleinAbstract:Drug rash with eosinophilia and systemic symptoms (DRESS) Syndrome is a rare, severe drug hypersensitivity Syndrome characterized by fever, rash, hematologic abnormalities, and systemic involvement. The pathogenesis of DRESS is unclear, but it is thought that the offending drug induces an immunemediated hypersensitivity reaction through defects in metabolism. Severe cases of DRESS often require aggressive treatment; however, current pharmacologic treatment options are limited. We describe a 66-year-old woman who presented with fever and rash 3 weeks after starting sulfasalazine treatment for rheumatoid arthritis. Investigation revealed diffuse lymphadenopathy, leukocytosis, eosinophilia, and hepatitis. She was diagnosed with DRESS Syndrome, sulfasalazine was discontinued, and she was treated with methylprednisolone. Her condition deteriorated, and she developed severe acute liver failure prompting evaluation for liver transplantation. Corticosteroid treatment was escalated to high-dose methylprednisolone, and N-acetylcysteine was started, which prompted improvement in her symptoms and liver function. To our knowledge, this is the first case report to describe the safe and successful use of corticosteroids and N-acetylcysteine to treat sulfasalazine-induced DRESS Syndrome. Given the potential morbidity and mortality of DRESS Syndrome, effective treatment alternatives for severe cases are needed. N-Acetylcysteine may be a safe adjunct to corticosteroid therapy for severe cases of sulfasalazine-induced DRESS Syndrome.
Aidan A. Long - One of the best experts on this subject based on the ideXlab platform.
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The importance of vancomycin in drug rash with eosinophilia and systemic symptoms (DRESS) Syndrome.
Allergy and asthma proceedings, 2012Co-Authors: Kimberly G. Blumenthal, Sarita U. Patil, Aidan A. LongAbstract:Drug rash with eosinophilia and systemic symptoms (DRESS) Syndrome characterized by fever, rash, eosinophilia, atypical lymphocytes, and multiorgan involvement has a significant mortality. Inpatient vancomycin use is increasing and appears to be emerging as an important etiology of DRESS Syndrome. This study highlights the importance of vancomycin as a cause of DRESS Syndrome. We reviewed all cases of DRESS Syndrome among inpatients consulted by the Allergy & Immunology service at Massachusetts General Hospital (MGH) from July 2009 through December 2010. We also reviewed the use of inpatient parenteral vancomycin over the past 4 years at MGH. Six patients fulfilled clinical criteria for DRESS Syndrome, including rash, fever, eosinophilia, and hepatitis, with five (83%) having vancomycin as the attributable cause. Onset of symptoms varied from 12 days to 4 weeks after start of vancomycin treatment. Systemic findings included atypical lymphocytes, lymphadenopathy, nephritis, hypotension, tachycardia, and pharyngitis. Treatment with corticosteroids was required in three cases. Recurrence of peripheral eosinophilia was a marker of disease relapse. In three of the five patients (60%), elevated human herpesvirus 6 (HHV6) IgG titers correlated with greater systemic involvement and prolonged time to resolution. MGH pharmacy records indicate a progressive increase in the number of patients treated with parenteral vancomycin over the last 4 years. Causative agents for DRESS Syndrome in an inpatient setting is likely different from that seen in the general population. With increasing use of vancomycin, we are likely to see more cases of DRESS Syndrome caused by vancomycin. Recognition of vancomycin as a common cause of inpatient DRESS Syndrome is important.
Naga Kanaparthy - One of the best experts on this subject based on the ideXlab platform.
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VANCOMYCIN-INDUCED DRESS Syndrome MASQUERADING AS RED MAN Syndrome
Annals of Allergy Asthma & Immunology, 2018Co-Authors: Saira Q. Zafar, Suman Pal, Naga KanaparthyAbstract:Introduction DRESS (drug reaction and eosinophilia with systemic symptoms) Syndrome is a severe drug-induced reaction most typically characterized by fevers, lymphadenopathy, transaminitis, kidney injury, and/or rash. We present a case of DRESS Syndrome after vancomycin administration masquerading as Red Man Syndrome. Case Description A 63-year old woman with history of Rheumatoid arthritis, hyperlipidemia, and recent right foot osteomyelitis presented to our hospital with fever, malaise, and a diffuse macular, erythematous, blanching rash which started after receiving vancomycin. She had been receiving vancomycin for 4 weeks at the time of presentation for her osteomyelitis. Her symptoms were initially attributed to Red Man Syndrome secondary to rapid infusion of vancomycin, and she was treated with antihistamines with immediate resolution of her rash. The next day, she was noted to have recurrent fevers, worsening rash, transaminitis, and significant eosinophilia. The RegiSCAR (European Registry of Severe Cutaneous Adverse Reaction Criteria) diagnosis score was indicative of “probable” DRESS Syndrome. The diagnosis of DRESS Syndrome due to vancomycin was made. She was started on high-dose prednisone and her symptoms resolved soon thereafter. Discussion Although mild drug reactions are fairly common at approximately 3% of hospitalized patients, there are also rare, potentially fatal cutaneous drug reactions an investigator must consider, such as DRESS Syndrome. Diagnosis of DRESS Syndrome must be considered as a differential when approaching a patient receiving vancomycin who has developed a rash and fever, as it can present with fatal complications and is reversible with rapid initiation of corticosteroid therapy.
Marwan H. Adwan - One of the best experts on this subject based on the ideXlab platform.
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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and the Rheumatologist
Current Rheumatology Reports, 2017Co-Authors: Marwan H. AdwanAbstract:Purpose of the Review The purpose of the review is to summarise the various drugs used in rheumatology practice implicated in the causation of DRESS Syndrome. Recent Findings 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. Summary 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.
