Hindosh Naif, Kotala Ragarupa, Nguyen Kristi, Pintor Alpiniano
Internal Medicine, St. Luke's University Health Network, Easton, USA.
Cureus. 2022 Oct 29;14(10):e30852. doi: 10.7759/cureus.30852. eCollection 2022 Oct.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a delayed adverse drug reaction that is characterized by fever, cutaneous manifestation, enlarged lymph nodes, hematologic abnormalities, and organ involvement. Multiple medications have been reported to cause DRESS with the presentation varying from drug to drug. Some cases are mild and can be managed by stopping the causative agent along with supportive measures; however, other cases can lead to multi-organ failure requiring systemic corticosteroids and organ transplant. Acute liver failure is a rare manifestation of DRESS. We report a patient who had recently completed a course of trimethoprim-sulfamethoxazole and presented with low-grade fever, diffuse skin rash, eosinophilia, elevated liver enzymes, acute kidney injury, and thrombocytopenia. DRESS was subsequently diagnosed based on history, physical examination, and relatively negative workup for an alternate diagnosis. The patient eventually showed improvement with steroid therapy without the need for a liver transplant. Due to its pharmacogenetic susceptibility, it is essential to recommend avoiding the causative medication for the patient's family members.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种迟发性药物不良反应，其特征为发热、皮肤表现、淋巴结肿大、血液学异常及器官受累。据报道，多种药物可导致DRESS，其表现因药物而异。一些病例症状较轻，停用致病药物并采取支持措施即可处理；然而，其他病例可导致多器官功能衰竭，需要使用全身性糖皮质激素及进行器官移植。急性肝衰竭是DRESS的一种罕见表现。我们报告1例患者，该患者近期完成了一个疗程的甲氧苄啶-磺胺甲恶唑治疗，之后出现低热、弥漫性皮疹、嗜酸性粒细胞增多、肝酶升高、急性肾损伤及血小板减少。随后根据病史、体格检查及相对排除其他诊断的检查结果诊断为DRESS。该患者最终经类固醇治疗后病情改善，无需进行肝移植。由于其药物遗传易感性，建议患者家属避免使用致病药物至关重要。
