Leblebici Figen, Soyal Özlem, Mutlu Nevzat Mehmet, Yağmurdur Hatice, Karaca Onur
Department of Anaesthesia and Intensive Care Unit, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Turk J Anaesthesiol Reanim. 2014 Feb;42(1):46-9. doi: 10.5152/TJAR.2013.44. Epub 2013 May 23.
Drug Rash with Eosinophilia and Systemic Symptoms" (DRESS) syndrome is a severe adverse drug reaction. The drugs most often implicated are anti-convulsants, bupropion, sulfonamides, sulfasalazine, allopurinol, minocycline, abacavir and neviparine. There are also immune and infectious causes that can lead to DRESS syndrome. A 70-year-old female patient had undergone endovascular coil embolization for intracranial aneurysm and experienced a generalised seizure postoperatively. She had been given diphenylhidantoin (DPH). Six days after DPH therapy, the patient had complained of widespread skin rash. Although DPH was replaced with levetiracetam afterwards, the skin rash deteriorated, causing facial oedema and swelling of the tongue. She had severe facial oedema with swelling of the tongue, causing disturbance of breathing. On the second day in the critical care unit, the patient's breathing deteriorated, leading successively to intubation and mechanical ventilation. The patient's rash was still persistent and the results of a punch biopsy taken from the lesions revealed superficial perivascular dermatitis involving spongiotic eosinophils compatible with spongiotic drug eruption. As a result, it is important to realise that medications we use can be the cause of a range of reactions ranging from simple rash to life threatening syndromes.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征是一种严重的药物不良反应。最常涉及的药物有抗惊厥药、安非他酮、磺胺类药物、柳氮磺胺吡啶、别嘌醇、米诺环素、阿巴卡韦和奈韦拉平。也有免疫和感染性原因可导致DRESS综合征。一名70岁女性患者因颅内动脉瘤接受了血管内线圈栓塞术，术后出现全身性癫痫发作。她接受了苯妥英（DPH）治疗。DPH治疗六天后，患者主诉全身皮疹。尽管之后用左乙拉西坦替代了DPH，但皮疹恶化，导致面部水肿和舌头肿胀。她面部严重水肿，舌头肿胀，导致呼吸障碍。在重症监护病房的第二天，患者呼吸恶化，相继进行了插管和机械通气。患者的皮疹仍然持续存在，从病变部位进行的皮肤活检结果显示，浅层血管周围性皮炎伴有海绵状嗜酸性粒细胞，符合海绵状药物疹。因此，重要的是要认识到我们使用的药物可能是一系列反应的原因，从简单的皮疹到危及生命的综合征。
