Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
J Am Acad Dermatol. 2012 Jun;66(6):e229-36. doi: 10.1016/j.jaad.2010.11.057. Epub 2011 Jun 11.
DRESS (drug rash with eosinophilia and systemic symptoms), also known as drug-induced hypersensitivity syndrome, is a severe, systemic drug reaction most commonly associated with aromatic anticonvulsants and sulfonamides. Patients typically present with fever, facial edema, cervical lymphadenopathy and a morbilliform eruption, which may progress to erythroderma. Hematologic abnormalities are a hallmark of the condition, including eosinophilia and atypical lymphocytosis. Visceral organ involvement typically manifests as hepatic dysfunction but may include lymphadenopathy, nephritis, interstitial pneumonitis, and myocarditis. Five to ten percent of patients with DRESS die from systemic complications, making timely recognition and treatment essential to prevent life-threatening manifestations. Myocarditis is a fatal and under-recognized manifestation of DRESS, which may occur long after the initial diagnosis. We review the literature of previously reported cases of DRESS and myocardial involvement, highlighting the presenting symptoms associated with cardiac involvement, treatments used, and the outcome for each patient. In addition, we offer an algorithm for early diagnosis, treatment, and subsequent monitoring of these patients.
药物反应伴嗜酸粒细胞增多和全身性症状（DRESS），又称药物诱导的超敏反应综合征，是一种严重的全身性药物反应，最常与芳香族抗惊厥药和磺胺类药物有关。患者通常表现为发热、面部水肿、颈淋巴结病和麻疹样皮疹，可能进展为红皮病。血液学异常是该病的特征之一，包括嗜酸性粒细胞增多和非典型淋巴细胞增多。内脏器官受累通常表现为肝功能障碍，但也可能包括淋巴结病、肾炎、间质性肺炎和心肌炎。5%至 10%的 DRESS 患者死于全身并发症，因此及时识别和治疗对于预防危及生命的表现至关重要。心肌炎是 DRESS 的一种致命且未被充分认识的表现，可能在最初诊断后很长时间才会出现。我们回顾了先前报道的 DRESS 和心肌受累病例的文献，强调了与心脏受累相关的临床表现、使用的治疗方法以及每位患者的预后。此外，我们提供了一种用于这些患者早期诊断、治疗和后续监测的算法。
