Oh Jaha, Singh Amandeep, Fonseca Maira, Muppidi Monica
Department of Internal Medicine, NYC Health and Hospitals/Lincoln, New York City, USA.
Department of Dermatology, NYC Health and Hospitals/Lincoln, New York City, USA.
Cureus. 2023 Jul 10;15(7):e41646. doi: 10.7759/cureus.41646. eCollection 2023 Jul.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe cutaneous drug reaction characterized by a skin rash, eosinophilia, atypical lymphocytosis, and involvement of multiple organs. The mortality rate of DRESS syndrome is moderate, and prompt diagnosis and treatment are essential. When DRESS syndrome is presented with significant hypereosinophilia (HE), it should be differentiated from other conditions that can cause HE through a comprehensive approach to diagnostic evaluation. Amoxicillin has been well-documented as a potential cause of DRESS syndrome. It is important to note that amoxicillin can trigger DRESS syndrome in patients who already have a known allergy to sulfasalazine, as well as when it is administered with a beta-lactamase inhibitor such as clavulanic acid. Here, we describe a case of amoxicillin alone-induced DRESS syndrome associated with significant reactive HE. A 39-year-old female presented with three days of shortness of breath, fatigue, facial swelling, and a generalized maculopapular skin rash. The patient endorsed taking amoxicillin two to three weeks prior to the presentation. Diagnostic tests revealed HE, significant generalized lymphadenopathy on computed tomography (CT) scans of the neck and abdomen, and bilateral interstitial infiltration on a CT scan of the chest suggestive of eosinophilic infiltration. Based on the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) scoring system, the case was categorized as "probable" DRESS syndrome related to amoxicillin. High-dose steroids were initiated as the treatment of choice for suspected DRESS syndrome. Other potential causes of HE were investigated and ruled out. The patient showed significant clinical improvement, with the normalization of absolute eosinophil count (AEC) and complete resolution of lung infiltrates on a repeat CT scan of the chest. The case highlights the importance of conducting a comprehensive diagnostic evaluation to differentiate DRESS syndrome from other causes of HE when significant HE is present. Prompt treatment with high-dose steroids is essential in managing patients with severe symptoms associated with DRESS syndrome. It is crucial to consider amoxicillin as a potential trigger for DRESS syndrome, even when there is no history of sulfasalazine allergy or concurrent administration of a beta-lactamase inhibitor.
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皮肤药物反应，其特征为皮疹、嗜酸性粒细胞增多、非典型淋巴细胞增多以及多器官受累。DRESS综合征的死亡率中等，及时诊断和治疗至关重要。当DRESS综合征伴有显著的高嗜酸性粒细胞增多（HE）时，应通过全面的诊断评估方法与其他可导致HE的疾病相鉴别。阿莫西林已被充分证明是DRESS综合征的潜在病因。需要注意的是，阿莫西林可在已对柳氮磺胺吡啶已知过敏的患者中引发DRESS综合征，以及在与β-内酰胺酶抑制剂（如克拉维酸）联合使用时引发该综合征。在此，我们描述一例单独使用阿莫西林诱发的DRESS综合征，伴有显著的反应性HE。一名39岁女性出现气短、乏力、面部肿胀和全身性斑丘疹皮疹3天。患者称在出现症状前两到三周服用过阿莫西林。诊断检查显示有HE、颈部和腹部计算机断层扫描（CT）显示显著的全身性淋巴结肿大，以及胸部CT扫描显示双侧间质性浸润，提示嗜酸性粒细胞浸润。根据欧洲严重皮肤不良反应登记处（RegiSCAR）评分系统，该病例被归类为与阿莫西林相关的“可能”DRESS综合征。开始使用大剂量类固醇作为疑似DRESS综合征的首选治疗方法。对HE的其他潜在病因进行了调查并排除。患者临床症状显著改善，绝对嗜酸性粒细胞计数（AEC）恢复正常，胸部重复CT扫描显示肺部浸润完全消退。该病例强调了在存在显著HE时进行全面诊断评估以鉴别DRESS综合征与其他HE病因的重要性。及时使用大剂量类固醇治疗对于管理患有与DRESS综合征相关严重症状的患者至关重要。即使没有柳氮磺胺吡啶过敏史或同时使用β-内酰胺酶抑制剂，也必须考虑阿莫西林是DRESS综合征的潜在触发因素。
