Akor Blessing O, Ukuonu Bob, Akor Alexander A, Ameh Ojonugua A, Otu Theresa, Yunusa Thairu, Onyeadi Onyinye, Lakai Grace
Department of Fam. Medicine, University of Abuja Teaching Hospital, P.M.B 228, Abuja-F.C.T. Nigeria.
Department of Int. Medicine, University of Abuja, P.M.B 117, Abuja, Nigeria.
Ghana Med J. 2021 Jun;55(2):169-172. doi: 10.4314/gmj.v55i2.13.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but severe adverse drug reaction with debilitating morbidity and high mortality. The interest of this presentation is to report a case of dress and the role of the healthcare coordinator (family physician) in early diagnosis, prompt treatment and coordination of care. We report a case of a 32-year-old male who was wrongly commenced on Dapsone for seizure disorder from a primary health centre. He presented two months later with a month history of severe dry cough, pleurisy, intermittent breathlessness and high-grade fever. He had a generalized pruritic rash with erythema and desquamation. There was marked oedema of the face and feet with generalized lymphadenopathy. He was jaundiced with tender hepatomegaly. He had dark coloured urine and a trace of proteinuria but normal renal function. There was marked leukocytosis (35*10/l) with eosinophilia (36%). His chest X-ray and viral screen for HBV, HCV and HIV were all negative. The multiple systemic presentations warranted a multidisciplinary review, and a final diagnosis of DRESS was made. His symptoms began to resolve within two days of withdrawal of the offending drug and commencement of oral corticosteroid with supportive care for his symptoms. At six weeks, there was a complete resolution of clinical features, and his laboratory parameters had returned to the baseline. Diagnosis of DRESS can be challenging, and a high index of suspicion is required. The multidisciplinary coordination of care by the first line physicians can also not be overemphasized for good outcomes.
None declared.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种罕见但严重的药物不良反应，发病率高且死亡率高。本报告的目的是报告一例DRESS病例以及医疗协调员（家庭医生）在早期诊断、及时治疗和护理协调中的作用。我们报告一例32岁男性，他在一家初级保健中心因癫痫障碍被错误地开始使用氨苯砜治疗。两个月后，他出现了一个月的严重干咳、胸膜炎、间歇性呼吸困难和高热病史。他有全身性瘙痒性皮疹，伴有红斑和脱屑。面部和足部有明显水肿，全身淋巴结肿大。他黄疸，肝肿大且有压痛。他尿液颜色深，有微量蛋白尿，但肾功能正常。有明显的白细胞增多（35×10⁹/L）伴嗜酸性粒细胞增多（36%）。他的胸部X线检查以及乙肝、丙肝和艾滋病毒的病毒筛查均为阴性。多种全身表现需要多学科会诊，最终诊断为DRESS。在停用致病药物并开始口服皮质类固醇及对其症状进行支持治疗后的两天内，他的症状开始缓解。六周时，临床症状完全消失，实验室参数恢复到基线水平（正常）。DRESS的诊断可能具有挑战性，需要高度的怀疑指数。一线医生的多学科护理协调对于取得良好结果也至关重要。
未声明。
