Department of Pediatrics, Rhode Island Hospital, Hasbro Children's Hospital, Providence, RI, USA.
Pediatr Crit Care Med. 2010 Jul;11(4):e38-43. doi: 10.1097/PCC.0b013e3181c5911a.
Drug rash, eosinophilia, and systemic symptoms syndrome is a type of drug hypersensitivity reaction characterized by the clinical triad of skin eruption, fever, and internal organ involvement. Drug rash, eosinophilia, and systemic symptoms syndrome has rarely been reported in association with vancomycin or in the pediatric population. There have only been four pediatric case reports of drug rash, eosinophilia, and systemic symptoms syndrome and three cases of drug rash, eosinophilia, and systemic symptoms syndrome involving vancomycin published in the English literature to date.
We describe two pediatric cases of drug rash, eosinophilia, and systemic symptoms syndrome to illustrate the range in severity of presentation. The first case illustrates drug rash, eosinophilia, and systemic symptoms syndrome associated with vancomycin exposure in a 14-yr-old boy with Duchenne muscular dystrophy after posterior spinal fusion, whose clinical presentation was indistinguishable from toxic shock syndrome. The second case illustrates a milder and more typical presentation of drug rash, eosinophilia, and systemic symptoms syndrome in a 14-yr-old boy being treated with minocycline for acne. We also present a review of the literature relevant to this syndrome.
: Drug rash, eosinophilia, and systemic symptoms syndrome is relatively unknown among general pediatricians and pediatric intensivists and may potentially become more common with the increasing use of long-term medications in the pediatric population. Our cases demonstrate the importance of an awareness of drug rash, eosinophilia, and systemic symptoms syndrome among general pediatricians and pediatric intensivists because drug rash, eosinophilia, and systemic symptoms syndrome may present in any range of severity, from indolent illness to frank and refractory shock.
药物疹、嗜酸性粒细胞增多和全身症状综合征是一种药物过敏反应，其特征是临床三联征：皮疹、发热和内脏器官受累。药物疹、嗜酸性粒细胞增多和全身症状综合征与万古霉素或儿科人群相关的情况很少见。迄今为止，英文文献中仅报道了四起与万古霉素相关的儿童药物疹、嗜酸性粒细胞增多和全身症状综合征病例，以及三例涉及万古霉素的药物疹、嗜酸性粒细胞增多和全身症状综合征病例。
我们描述了两例儿科药物疹、嗜酸性粒细胞增多和全身症状综合征病例，以说明其临床表现的严重程度范围。第一个病例说明了药物疹、嗜酸性粒细胞增多和全身症状综合征与万古霉素暴露的相关性，在一名患有杜氏肌营养不良症的 14 岁男孩中发生，该男孩在接受后路脊柱融合术后出现了与中毒性休克综合征难以区分的临床表现。第二个病例说明了药物疹、嗜酸性粒细胞增多和全身症状综合征在一名 14 岁男孩中表现更为温和且更典型，该男孩因痤疮接受米诺环素治疗。我们还对与该综合征相关的文献进行了综述。
药物疹、嗜酸性粒细胞增多和全身症状综合征在普通儿科医生和儿科重症监护医生中相对未知，随着儿科人群中长期用药的使用增加，可能会变得更为常见。我们的病例表明，普通儿科医生和儿科重症监护医生应意识到药物疹、嗜酸性粒细胞增多和全身症状综合征的存在，因为该综合征的临床表现可从无症状疾病到明显和难治性休克，严重程度不一。
