Bhatt Kinal Paresh, Alsoud Fahed, Prashad Adesh, Ortega-Tola Jose, Singh Virendra Ravat, Patel Pooja, Michel George
Larkin Community Hospital, South Miami, FL, USA.
Discoveries (Craiova). 2023 Aug 27;11(1):e170. doi: 10.15190/d.2023.9. eCollection 2023 Jul-Sep.
Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug induced hypersensitivity (DiHS) is a rare, however a severe hypersensitivity reaction with a mortality rate of up to 10%, accounting for 10 to 20% of all cutaneous drug reactions in hospitalized patients. The clinical features of DRESS/DiHS may be challenging to recognize and diagnose, since they are delayed, stepwise, and heterogeneous. The classic presentation of DRRSS/DiHS involves a combination of cutaneous, hematologic, and internal organ involvement with a 2 to 8 weeks latency between drug exposure and the onset of symptoms. Finding the culprit drug in our case was difficult as the patient was taking multiple antibiotics. Drugs such as vancomycin and cefepime used before the rash outbreak for post-reconstructive surgery for left toal knee arthroplasty (TKA) approximately four weeks before the onset of the rash are likely offending agents. This patient also had multi-visceral involvement with eosinophilia and systemic symptoms. The current treatment guidelines for DRESS/DiHS are primarily based on expert opinion, as no randomized control trials exist. After the prompt withdrawal of the offending drug, systemic corticosteroids seem to have shown the best outcome for patients. Delaying discontinuing offending medications and initiating corticosteroid treatment may lead to poor results. The present case emphasizes that the close observation of patients with drug eruption induced by antibiotics is imperative. Primary care team should be able to promptly diagnose patients with DRESS syndrome, detect causative drug, and play a crucial role in the timely evaluation and treatment to reduce mortality rate. The later phase disease relapse or autoimmune complications may occur up to 5 years following the initial presentation. Therefore, we advised the patient to have an outpatient follow up for appropriate testing, including but not limited to genetic susceptibility due to the high risk of relapse and emerging risk of autoimmune diseases.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS），也称为药物诱导的超敏反应（DiHS），是一种罕见但严重的超敏反应，死亡率高达10%，占住院患者所有皮肤药物反应的10%至20%。DRESS/DiHS的临床特征可能难以识别和诊断，因为它们具有延迟性、渐进性和异质性。DRESS/DiHS的典型表现包括皮肤、血液学和内脏器官受累，在接触药物和症状发作之间有2至8周的潜伏期。在我们的病例中，由于患者正在服用多种抗生素，很难找到罪魁祸首药物。皮疹爆发前约四周用于左膝全膝关节置换术（TKA）重建术后的万古霉素和头孢吡肟等药物可能是致病因素。该患者还出现了多脏器受累并伴有嗜酸性粒细胞增多和全身症状。目前DRESS/DiHS的治疗指南主要基于专家意见，因为尚无随机对照试验。迅速停用致病药物后，全身用糖皮质激素似乎对患者显示出最佳疗效。延迟停用致病药物并开始糖皮质激素治疗可能导致不良结果。本病例强调，必须密切观察抗生素引起的药疹患者。基层医疗团队应能够及时诊断DRESS综合征患者，检测出致病药物，并在及时评估和治疗中发挥关键作用以降低死亡率。初始表现后长达5年可能会出现疾病后期复发或自身免疫并发症。因此，由于复发风险高和自身免疫性疾病出现风险，我们建议患者进行门诊随访以进行适当检查，包括但不限于基因易感性检测。
