Time is skin: what does the emergency physician need to know about DRESS?

Abstract

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome, also known as Drug Induced Hypersensitivity Syndrome (DIHS), is an acute drug-induced hypersensitivity reaction. The pathogenesis of this syndrome, which can develop due to many drugs, especially antiepileptic agents, is not known exactly. This syndrome, which was denominated “hydantoin hypersensitivity” in 1950, was renamed as “DRESS syndrome” by Bocquet and his colleagues in 1996 and the first diagnostic criteria were determined.
Unlike syndromes that may develop due to other drugs, DRESS syndrome customarily commences 2-8 weeks after the commencement of the drug, and symptoms perpetuate to progress after discontinuation of the responsible drug. Symptoms such as fever, lymphadenopathy, hematological disorders, maculopapular rash and internal organ involvement are common in this syndrome.
Diagnosis of DRESS syndrome is often difficult, as the clinical manifestations are varied and the latent period after the initiation of drug use can be up to 3 months. Thus, it is thought that the diagnosis of DRESS should be in the minds of all doctors, especially emergency physicians.

Keywords

• DRESS
• drug rash with eosinophilia systemic symptoms
• ED

Zaman cilttir: Acil servis hekimleri DRESS sendromu hakkında ne bilmeli?

Abstract

Drug Rash with Eoshinophilia and Systemic Symptoms (DRESS) sendromu ve ya diğer adıyla da bilinen İlaçla indüklenen hipersensitivite sendromu (Drug Induced Hypersensitivity Syndrome (DIHS), ilaca bağlı akut bir hipersensitivite reaksiyonudur.
Başta antiepileptik ajanlar olmak üzere birçok ilaca bağlı gelişebilen bu sendromun patogenezi tam olarak bilinmemektedir. Bazı ilaçların detoksifikasyonundaki yetersizliğe bağlı artan reaktif metabolitlerin immünolojik reaksiyona neden olduğu tahmin edilmektedir. İlaçların yanısıra herpesvirüs ve Ebstein Barr Virüsü gibi benzer bir reaksyonlar DRESS sendromuna yola açabildiği düşünülmektedir.
DRESS sendromunun diğer ilaçlara bağlı gelişebilen sendromlardan farklı olarak Klinik bulgularının genellikle ilacın kullanılmaya başlanmasından 2-8 hafta sonrasında başlaması ve sorumlu ilacın kesilmesiyle semptomların ilerlemeye devam etmesidir.
Ateş, lenfadenopati, hematolojik bozukluklar, makülopapüler döküntü ve ve iç organ tutulumları gibi bulgular bu sendromda rastlamak sıktır.
Klinik bulguların çeşitli olması ve ilaç kullanımının başlaması sonrasındaki latent periyodun 3 aya kadar uzun olabilmesi nedeniyle DRESS sendromunun tanısı sıklıkla güçtür. Tanısı gözden kaçtığında mortalitesi %10-20 civarında olup oldukça önemli bir klinik tablodur.

Keywords

• DRESS
• eozinofili ve sistemik semptomlarla seyreden ilaç reaksiyonu
• acil servis

References

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