Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Can J Anaesth. 2012 Mar;59(3):295-8. doi: 10.1007/s12630-011-9644-x. Epub 2012 Jan 20.
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multi-system reaction defined by fever, rash, eosinophilia, and internal organ involvement. The condition typically occurs one to eight weeks following exposure to inciting medications. In severe cases, it can develop into multi-organ system failure and death. We present a case of DRESS syndrome with mucosal edema that led to extreme difficulties with airway management.
A 65-yr-old male treated for an esophageal perforation with broad-spectrum antibiotics developed fever, eosinophilia, and extensive rash consistent with DRESS syndrome. This condition resulted in a rapid progression to multi-organ system dysfunction, severe hemodynamic instability, and the need for high-dose vasopressors and tracheal intubation. Extensive mucous membrane involvement led to significant complications with airway management and a nearly impossible tracheal intubation, features in the disease not previously described. With the airway secure, initiation of steroids resulted in regression of the disease within 24 hr, resolution of airway edema, and uneventful tracheal extubation a few days later.
We emphasize the need for early identification of DRESS syndrome as well as the possible airway implications associated with this increasingly recognized clinical entity.
药物疹伴嗜酸性粒细胞增多和全身症状（DRESS）综合征是一种严重的多系统反应，其特征为发热、皮疹、嗜酸性粒细胞增多和内脏器官受累。通常在接触诱发药物后 1 至 8 周内发生。在严重的情况下，它可能发展为多器官系统衰竭和死亡。我们报告了一例 DRESS 综合征伴黏膜水肿的病例，导致气道管理极其困难。
一名 65 岁男性因食管穿孔接受广谱抗生素治疗后出现发热、嗜酸性粒细胞增多和广泛皮疹，符合 DRESS 综合征的表现。这种情况迅速进展为多器官系统功能障碍、严重的血流动力学不稳定，需要大剂量血管加压素和气管插管。广泛的黏膜受累导致气道管理出现严重并发症，几乎无法进行气管插管，这是该疾病以前未描述过的特征。气道得到保障后，开始使用类固醇，24 小时内疾病消退，气道水肿缓解，几天后顺利拔出气管导管。
我们强调需要早期识别 DRESS 综合征以及与这种日益被认识的临床实体相关的可能的气道影响。
