Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
Department of Dermatology, University of California, San Francisco, California.
J Am Acad Dermatol. 2024 May;90(5):911-926. doi: 10.1016/j.jaad.2023.02.073. Epub 2023 Jul 28.
Drug-induced hypersensitivity syndrome, also known as drug reaction with eosinophilia and systemic symptoms, is a severe cutaneous adverse reaction characterized by an exanthem, fever, and hematologic and visceral organ involvement. The differential diagnosis includes other cutaneous adverse reactions, infections, inflammatory and autoimmune diseases, and neoplastic disorders. Three sets of diagnostic criteria have been proposed; however, consensus is lacking. The cornerstone of management is immediate discontinuation of the suspected drug culprit. Systemic corticosteroids remain first-line therapy, but the literature on steroid-sparing agents is expanding. Longitudinal evaluation for sequelae is recommended. Adjunctive tests for risk stratification and drug culprit identification remain under investigation. Part II of this continuing medical education activity begins by exploring the differential diagnosis and diagnosis of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms and concludes with an evidence-based overview of evaluation and treatment.
药物诱导的超敏反应综合征，又称药物反应伴嗜酸性粒细胞增多和全身症状，是一种严重的皮肤不良反应，其特征为出疹、发热以及血液和内脏器官受累。鉴别诊断包括其他皮肤不良反应、感染、炎症和自身免疫性疾病以及肿瘤性疾病。已经提出了三套诊断标准，但尚未达成共识。治疗的基石是立即停用可疑的致病药物。全身皮质类固醇仍然是一线治疗药物，但关于类固醇保留药物的文献正在不断增加。建议对后遗症进行纵向评估。用于风险分层和确定致病药物的辅助检查仍在研究中。本继续教育活动的第二部分首先探讨了药物诱导的超敏反应综合征/药物反应伴嗜酸性粒细胞增多和全身症状的鉴别诊断和诊断，最后基于证据对评估和治疗进行了概述。
