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Drug Reaction with Eosinophilia and Systemic Symptoms
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Journal Article
Drug Reaction with Eosinophilia and Systemic Symptoms
2024
Overview
Key PointsDrug Reaction with Eosinophilia and Systemic SymptomsDrug reaction with eosinophilia and systemic symptoms (DRESS) is a T-cell–mediated severe cutaneous adverse reaction characterized by rash, fever, internal organ involvement, and systemic manifestations after prolonged exposure to a medication.DRESS accounts for approximately one fifth of cutaneous reactions among hospitalized patients; antibiotics are one of the most commonly identified triggers.Approximately 5% of DRESS cases result in death; the patients who survive may have relapses in addition to medical and psychological sequelae.The differential diagnosis includes morbilliform drug eruption; other severe cutaneous adverse reactions, such as the Stevens–Johnson syndrome and acute generalized exanthematous pustulosis; and additional conditions, such as hemophagocytic lymphohistiocytosis, angioimmunoblastic T-cell lymphoma, and acute graft-versus-host disease.The validated European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) scoring system is a rubric used to diagnose DRESS; however, elements of the diagnostic criteria may manifest at different time points, some late in the course of the disease.After identification and removal of the causative drug, treatment of DRESS consists of supportive care and glucocorticoids; glucocorticoid-sparing drugs and targeted biologic treatments are emerging as alternatives and complements to such treatment.There is no validated test to establish the cause of DRESS; dermatologists or allergist–immunologists may help assess drug causality and determine alternative drug therapy.
Publisher
Massachusetts Medical Society
Subject
