Fever, eosinophilia, and abnormal liver function are early signs suggestive of DRESS: A comparative study between DRESS and MPE
Journal
Dermatologica Sinica
Journal Volume
36
Journal Issue
1
Pages
25-29
Date Issued
2018
Author(s)
Hsu, Shao-Hsuan
Yang, Che-Wen
Hsieh, Yi-Chun
Liang, Cher-Wei
Cheng, Yu-Pin
Abstract
Background/Objective: There is a rising awareness of drug reaction with eosinophilia and systemic symptoms (DRESS) due to its possible morbidity and mortality. Early diagnosis of DRESS is crucial for administering timely treatment; however, prompt diagnosis based on its early presentation can be quite problematic due to its clinical resemblance to common maculopapular eruptions (MPE). Methods: A retrospective cohort study of patient data from September 2010 to June 2016 was conducted to compare the clinical presentations of DRESS and MPE validated by the RegiSCAR scoring system. The demographic data, clinical presentations, and histopathological patterns were reviewed. Results: Fifty-eight patients with DRESS and 29 patients with MPE were included. The mean age at diagnosis of DRESS was 47 years (range: 2–82 years), and female patients predominated by a ratio of 2.2:1. The three most common culprit medications for DRESS were allopurinol, sulfasalazine, and trimethoprim/sulfamethoxazole. The most significant differences between the DRESS and MPE groups were the presence of fever, peripheral blood eosinophilia and atypical lymphocytosis, characteristic skin lesions, abnormal liver functions, and prolonged resolution of skin lesions for more than 15 days in the DRESS patients. The most common histologic features in the DRESS patients were coexistent eczematous, interface dermatitis, and vascular damage patterns, or interface dermatitis alone. The concurrence of fever, peripheral blood eosinophilia, and abnormal liver function within three days of visiting a medical facility were more common in cases of DRESS than of MPE (24.1% vs. 0%, P = 0.004). Conclusion: Although DRESS and MPE look similar, especially in the early stage of DRESS, the concurrence of fever, peripheral blood eosinophilia, and abnormal liver functions within three days of visiting a medical facility might aid in the early diagnosis of DRESS. ? 2017
Subjects
Abnormal liver function
Atypical lymphocytosis
Culprit medication
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Maculopapular eruption (MPE)
SDGs
Other Subjects
allopurinol; cotrimoxazole; dapsone; phenytoin; salazosulfapyridine; adult; Article; blood vessel injury; body surface; clinical feature; cohort analysis; comparative study; dermatitis; DRESS syndrome; eosinophilia; erythroderma; face edema; female; fever; histopathology; human; human tissue; liver function; lymphocytosis; maculopapular rash; major clinical study; male; papule; purpuric rash; retrospective study; skin biopsy; skin defect
Publisher
Elsevier Ltd
Type
journal article