Swaminathan Gowri, Miller Daniel, Noff Nicole, Bhutta Zara, Muratori Jonathan, Rauf Faateh, Patrizi Santino, Ozkan Bike, Lopez Ricardo
Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health and Hospitals/Queens Hospital Center, New York, USA.
Cureus. 2024 Sep 16;16(9):e69503. doi: 10.7759/cureus.69503. eCollection 2024 Sep.
Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction (SCAR) characterized by an extensive skin rash associated with visceral organ involvement, fever, eosinophilia, atypical lymphocytosis, and lymphadenopathy. Toxic epidermal necrolysis (TEN) is a more severe, distinct adverse cutaneous reaction that causes extensive necrosis and detachment of the epidermis, involving over 30% of the body surface area (BSA). Hemophagocytic lymphohistiocytosis (HLH), a form of excessive immune activation, is known to be associated with SCARs such as DRESS. We present a peculiar case of overlap between different SCARs to reiterate their gravity, a severe form of DRESS triggered by the use of allopurinol overlapping with the aggressive TEN possibly from interaction with vancomycin administered for severe sepsis, which was complicated by a fatal case of HLH.
药物性皮疹伴嗜酸性粒细胞增多和全身症状（DRESS）是一种严重的皮肤不良反应（SCAR），其特征为广泛的皮疹，并伴有内脏器官受累、发热、嗜酸性粒细胞增多、非典型淋巴细胞增多和淋巴结病。中毒性表皮坏死松解症（TEN）是一种更严重、独特的皮肤不良反应，可导致表皮广泛坏死和脱落，累及超过30%的体表面积（BSA）。噬血细胞性淋巴组织细胞增生症（HLH）是一种过度免疫激活形式，已知与DRESS等SCAR相关。我们报告了一例不同SCAR之间重叠的特殊病例，以重申其严重性，即使用别嘌醇引发的严重DRESS与可能因与用于严重脓毒症的万古霉素相互作用而导致的侵袭性TEN重叠，并伴有致命的HLH病例。
