Wang Li, Li Lin-Feng
Department of Dermatology, Allergy and Clinical Immunology Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Medicine (Baltimore). 2017 Mar;96(11):e6346. doi: 10.1097/MD.0000000000006346.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity reaction characterized by skin rash, fever, blood abnormalities, and multiple organ involvement. The diagnosis of DRESS syndrome is often delayed because of its variable presentation. Prompt withdrawal of the culprit drug is the definitive treatment. DRESS syndrome induced by antituberculosis drugs has rarely been reported.
A 50-year-old man admitted to our hospital with recurrent episodes of progressive rash, fever, eosinophilia, lymphadenopathy, hepatic, and pulmonary involvement were experienced after repeat trials of the same antituberculosis drugs.
We diagnosed it as DRESS caused by antituberculosis drugs.
The case responded well to treatment with systemic corticosteroids and intravenous immunoglobulins. However, repeated bouts of infection with methicillin-resistant Staphylococcus aureus occurred during treatment (clavicular osteomyelitis and knee septic arthritis). He was cured after treatment with linezolid.
The patient was discharged on day 112. At 8-month follow-up, there was no relapse of drug eruption and joint swelling.
Early diagnosis and prompt withdrawal of all suspected drugs is a key tenet of the treatment of DRESS. Our case report highlights the risks inherent in delayed diagnosis of DRESS and the challenges in the clinical management of this condition. Pulmonary manifestations with radiological changes on chest X-ray and CT can be seen in DRESS. These changes need to be differentiated from those caused by pulmonary infections. Clavicular osteomyelitis infected with MRSA may be caused by iatrogenic injury during subclavian vein catheterization. This type of MRSA infections should be treated for 4 to 6 weeks. Blood eosinophilia could be a useful marker of disease progression and treatment response in patients with DRESS. However, more experience and clinical evidence is needed to confirm this.
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性过敏反应，其特征为皮疹、发热、血液异常以及多器官受累。由于其表现多样，DRESS综合征的诊断常常延迟。立即停用致病药物是决定性的治疗方法。由抗结核药物引起的DRESS综合征鲜有报道。
一名50岁男性因反复出现进行性皮疹、发热、嗜酸性粒细胞增多、淋巴结病、肝脏和肺部受累而入院，这些症状是在重复使用相同抗结核药物后出现的。
我们将其诊断为由抗结核药物引起的DRESS综合征。
该病例对全身用皮质类固醇和静脉注射免疫球蛋白治疗反应良好。然而，治疗期间反复发生耐甲氧西林金黄色葡萄球菌感染（锁骨骨髓炎和膝关节化脓性关节炎）。使用利奈唑胺治疗后他痊愈了。
患者于第112天出院。在8个月的随访中，药疹和关节肿胀未复发。
早期诊断并立即停用所有可疑药物是治疗DRESS的关键原则。我们的病例报告强调了DRESS延迟诊断所固有的风险以及这种疾病临床管理中的挑战。DRESS可出现胸部X线和CT上有放射学改变的肺部表现。这些改变需要与肺部感染引起的改变相鉴别。锁骨下静脉置管期间的医源性损伤可能导致耐甲氧西林金黄色葡萄球菌感染的锁骨骨髓炎。这种类型的耐甲氧西林金黄色葡萄球菌感染应治疗4至6周。血液嗜酸性粒细胞增多可能是DRESS患者疾病进展和治疗反应的有用标志物。然而，需要更多的经验和临床证据来证实这一点。
