Downs Darrell, Sivakolundu Keerthana, Lim Nica, Kandula Manasa
Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA.
J Community Hosp Intern Med Perspect. 2023 Nov 4;13(6):8-12. doi: 10.55729/2000-9666.1248. eCollection 2023.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening condition associated with variable clinical presentations including rash, fevers, eosinophilia, and visceral organ involvement. It is a hypersensitivity reaction, and most cases have an identifiable inciting factor of drug exposure.
We present an interesting case of DRESS syndrome in a 97-year-old patient after she was treated with valacyclovir for herpes zoster. Her presentation included an exanthematous rash, acute kidney injury and progression to development of mildly elevated liver enzymes. Skin biopsy was consistent with DRESS. Patient initially responded to steroids but had a relapse during steroid taper. She eventually responded well to a slow prolonged steroid taper and had complete resolution of organ dysfunction and skin manifestations.
Valacyclovir is a rare but important cause of DRESS. A thorough history of the illness timeline and a high index of clinical suspicion is required for the prompt diagnosis and treatment of the condition. Apart from withdrawal of the offending agent, a slow prolonged taper of steroids is the current recommended treatment as rapid reduction of steroid dosage can lead to a relapse of cutaneous and systemic symptoms.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种潜在的危及生命的疾病，其临床表现多样，包括皮疹、发热、嗜酸性粒细胞增多及内脏器官受累。它是一种超敏反应，大多数病例有明确的药物暴露诱发因素。
我们报告一例97岁患者在接受伐昔洛韦治疗带状疱疹后发生DRESS综合征的有趣病例。其表现包括皮疹、急性肾损伤以及进展为轻度肝酶升高。皮肤活检结果符合DRESS。患者最初对类固醇治疗有反应，但在类固醇减量过程中复发。她最终对缓慢延长的类固醇减量方案反应良好，器官功能障碍和皮肤表现完全消退。
伐昔洛韦是DRESS的罕见但重要病因。对于该疾病的快速诊断和治疗，需要详尽的疾病时间线病史及高度的临床怀疑指数。除停用致病药物外，目前推荐缓慢延长的类固醇减量方案，因为快速减少类固醇剂量可导致皮肤和全身症状复发。
