J Investig Allergol Clin Immunol. 2014;24(6):425-30.
DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome is characterized by fever, rash, eosinophilia, and multiorgan failure. Previous reports have described differences in clinical and laboratory findings of DRESS syndrome depending on the inducing drug. Piperacillin has been reported as the drug responsible for this syndrome in 3 patients.
To analyze and describe the clinical, laboratory, and allergy study findings of piperacillin-induced DRESS.
Retrospective case series of patients diagnosed with DRESS associated with piperacillin-tazobactam (Pip/Taz) according to the Kardaun diagnostic score criteria. Assessment of causality was established using the Spanish Pharmacovigilance System and the lymphocyte transformation test (LTT). The allergy study included skin and epicutaneous tests.
Eight patients were diagnosed with DRESS due to Pip/Taz (3 probable and 5 definite cases). Skin rash was observed in all cases and facial edema in 50%; the mean latency period was 18 days. Fever was present in 7 patients. Liver and kidney injuries were detected in 6 and 3 patients, respectively. All patients had eosinophilia and a full recovery. The LTT to Pip/Taz was strongly positive in all patients, with a stimulation index of over 6. Three of 3 patients had a positive intradermal test to Pip/Taz, and 1 of 4 had a positive patch test. All patients had a negative LTT to carbapenems.
We have reported on the first case series of piperacillin-induced DRESS. A latency period of 18 days, skin rash, eosinophilia, fever, liver injury, and good prognosis were the most common features. The allergy study, and the LTT in particular, was highly useful for identifying Pip/Taz as the culprit drug and piperacillin as the responsible active ingredient.
药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征的特征为发热、皮疹、嗜酸性粒细胞增多和多器官功能衰竭。既往报道称，不同诱导药物的 DRESS 综合征的临床和实验室表现存在差异。哌拉西林已被报道为导致该综合征的 3 种药物之一。
分析和描述哌拉西林致 DRESS 的临床、实验室和过敏研究结果。
根据 Kardaun 诊断评分标准，回顾性分析诊断为哌拉西林-他唑巴坦（Pip/Taz）相关 DRESS 的病例系列。使用西班牙药物警戒系统和淋巴细胞转化试验（LTT）确定因果关系。过敏研究包括皮肤和表皮测试。
8 例患者被诊断为 Pip/Taz 导致的 DRESS（3 例可能，5 例确定）。所有病例均出现皮疹，50%出现面部水肿；潜伏期平均为 18 天。7 例患者发热。6 例和 3 例患者分别检测到肝和肾损伤。所有患者均有嗜酸性粒细胞增多和完全恢复。所有患者对 Pip/Taz 的 LTT 均为强阳性，刺激指数超过 6。3 例对 Pip/Taz 皮内试验阳性，1 例对 Pip/Taz 斑贴试验阳性。所有患者对碳青霉烯类药物的 LTT 均为阴性。
我们报告了首例哌拉西林诱导的 DRESS 病例系列。潜伏期 18 天、皮疹、嗜酸性粒细胞增多、发热、肝损伤和良好预后是最常见的特征。过敏研究，特别是 LTT，对于确定 Pip/Taz 为致病药物和哌拉西林为活性成分非常有用。
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