Department of Pediatrics, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304, USA.
Pediatrics. 2011 Jan;127(1):e235-8. doi: 10.1542/peds.2010-0374. Epub 2010 Dec 6.
Drug-related eosinophilia with systemic symptoms (DRESS) is a potentially life-threatening, multiorgan condition that can result from drug treatment. Antiepileptic medications have provided the best-studied link of any class of medications. Here, we report the case of a 16-year-old boy with long-standing bipolar disorder who was chronically treated with aripiprazole and fluoxetine and developed DRESS syndrome after ingestion of high doses of caffeine. His classic presentation with fever, morbilliform rash, lymphadenopathy, and visceral involvement, including leukocytosis, eosinophilia, and hepatitis, was consistent with this diagnosis. Furthermore, the patient's symptoms dramatically improved after corticosteroid therapy and discontinuation of all psychotropic medications. We propose that the development of DRESS syndrome is a net result of inconsistent medication adherence coupled with the ingestion of near-toxic doses of caffeine, which can lead to rhabdomyolysis and, through renal impairment, lead to the accumulation of toxic oxidative metabolites of either or both psychotropic medications. We also present one of the few reported cases of caffeine-induced rhabdomyolysis and propose its role in the development of DRESS in this patient.
药物相关性嗜酸性粒细胞增多伴全身症状（DRESS）是一种潜在危及生命的多器官疾病，可由药物治疗引起。抗癫痫药物与任何一类药物的相关性研究最多。在这里，我们报告了一例患有长期双相情感障碍的 16 岁男孩的病例，他长期接受阿立哌唑和氟西汀治疗，在摄入大剂量咖啡因后出现 DRESS 综合征。他的典型表现为发热、麻疹样皮疹、淋巴结病和内脏受累，包括白细胞增多、嗜酸性粒细胞增多和肝炎，符合这一诊断。此外，患者在接受皮质类固醇治疗和停用所有精神药物后症状显著改善。我们提出，DRESS 综合征的发生是药物依从性不一致加上摄入接近毒性剂量的咖啡因的综合结果，咖啡因可导致横纹肌溶解，并通过肾功能损害导致两种精神药物的毒性氧化代谢物的积累。我们还报告了少数几例咖啡因引起的横纹肌溶解症病例之一，并提出其在该患者 DRESS 发展中的作用。
