Yadav Pooja, Rao Gopal Krishna, Rataboli Padmanabh V, Gurav Shailendra S
Department of Pharmacology, Goa College of Pharmacy, Government of Goa, 18th June Road, Panaji, Goa-403001, India.
Department of Pharmaceutical Chemistry, Goa College of Pharmacy, Government of Goa, 18th June Road, Panaji, Goa-403001, India.
Curr Drug Saf. 2025;20(3):388-393. doi: 10.2174/0115748863321106240903111048.
Adverse Drug Reactions (ADRs) are unexpected reactions to a medicine administered in the correct manner and at the proper dosage. Drug Rash with Eosinophilia and Systemic Symptoms syndrome (DRESS syndrome) is a Severe Cutaneous Adverse Reaction (SCAR) type of ADR with complicated clinical features involving several organ systems of the body; frequently involved organs are the liver, kidney, lungs, and other organs. Prompt recognition and correct diagnosis, followed by withdrawal of the causative agent, can promote appropriate treatment, accelerate recovery, and reduce the related morbidity and mortality.
We have, herein, presented a case of a 42-year-old female with a history of leflunomide intake for plantar fasciitis. The patient subsequently developed fever, gastrointestinal tract disturbance, facial edema, liver injury, skin rash, hematologic abnormalities (eosinophilia), hepatosplenomegaly, and lymph node enlargement. The probability of leflunomide-induced DRESS syndrome was rated as "definite", with with a score of eight graded by RegiSCAR. The suspected causative agent was withdrawn, and the patient was managed symptomatically. Following her management and discharge, she again encountered similar complaints after administration of the cefuroxime tablet. The causality assessment of the reactions was done using the WHOUMC scale and Naranjo's assessment scale, and a "probable" reaction was found for both drugs.
The presented case contributes to the existing global literature regarding exceptional clinical presentations. Leflunomide and cefuroxime drugs have the potential to cause DRESS syndrome. Thus, they should be handled cautiously, and if such a reaction occurs, it should be reported to the responsible authorities.
药物不良反应（ADR）是指以正确方式和适当剂量使用药物时出现的意外反应。药物性皮疹伴嗜酸性粒细胞增多和全身症状综合征（DRESS综合征）是一种严重皮肤不良反应（SCAR）类型的ADR，具有复杂的临床特征，累及身体的多个器官系统；常见受累器官有肝脏、肾脏、肺及其他器官。及时识别和正确诊断，随后停用致病药物，可促进恰当治疗、加速康复并降低相关发病率和死亡率。
在此，我们报告了一例42岁女性患者，有因足底筋膜炎服用来氟米特的病史。该患者随后出现发热、胃肠道紊乱、面部水肿、肝损伤、皮疹、血液学异常（嗜酸性粒细胞增多）、肝脾肿大及淋巴结肿大。根据RegiSCAR分级，来氟米特诱发DRESS综合征的可能性被评为“肯定”，得分为8分。停用可疑致病药物，对患者进行对症治疗。在治疗和出院后，她服用头孢呋辛酯片后再次出现类似症状。使用WHOUMC量表和Naranjo评估量表对反应进行因果关系评估，发现两种药物均为“很可能”的反应。
本病例为现有关于特殊临床表现的全球文献增添了内容。来氟米特和头孢呋辛酯药物有诱发DRESS综合征的可能性。因此，应谨慎使用，如果发生此类反应，应向相关部门报告。
