DRESS syndrome natural history, complications and prognosis: Difference between revisions
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*Initially, patients usually develop non-specific signs and symptoms, namely fever and rash, making the early diagnosis of DRESS syndrome difficult upon patient presentation. | *Initially, patients usually develop non-specific signs and symptoms, namely fever and rash, making the early diagnosis of DRESS syndrome difficult upon patient presentation. | ||
*Additional clinical manifestations follow, and patients may subsequently develop lymphadenopathy, visceral disease (typically liver involvement), and worsening of the skin eruption. | *Additional clinical manifestations follow, and patients may subsequently develop lymphadenopathy, visceral disease (typically liver involvement), and worsening of the skin eruption. | ||
*The nature of the visceral involvement is thought to be associated with the identity of the triggering drug. | *The nature of the visceral involvement is thought to be associated with the identity of the triggering drug:<ref name="pmid23882307">{{cite journal| author=Choudhary S, McLeod M, Torchia D, Romanelli P| title=Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome. | journal=J Clin Aesthet Dermatol | year= 2013 | volume= 6 | issue= 6 | pages= 31-7 | pmid=23882307 | doi= | pmc=PMC3718748 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23882307 }} </ref> | ||
:*Hepatic and GI involvement has been associated with abacavir | :*Hepatic and GI involvement has been associated with abacavir | ||
:*Renal involvement has been associated with allopurinol | :*Renal involvement has been associated with allopurinol | ||
Revision as of 15:58, 21 September 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Natural History
- DRESS syndrome is characterized by a prolonged latency period.
- Clinical manifestations of DRESS syndrome are usually delayed. Earliest manifestations may appear 2-8 weeks following the administration of triggering drug.
- Initially, patients usually develop non-specific signs and symptoms, namely fever and rash, making the early diagnosis of DRESS syndrome difficult upon patient presentation.
- Additional clinical manifestations follow, and patients may subsequently develop lymphadenopathy, visceral disease (typically liver involvement), and worsening of the skin eruption.
- The nature of the visceral involvement is thought to be associated with the identity of the triggering drug:[1]
- Hepatic and GI involvement has been associated with abacavir
- Renal involvement has been associated with allopurinol
- Pulmonary involvement has been associated with abacavir and minocycline
- In the majority of cases, DRESS syndrome resolves following the discontinuation of triggering drug, but clinical manifestations may persist up to 3 months.
Complications
- Organ involvement is considered the most important complication of DRESS syndrome.
- Complications of DRESS syndrome include the following:
- Hepatitis and hepatic necrosis
- Interstitial nephritis
- Pneumonitis
- Eosinophilic pneumopathy
- Carditis
- Encephalopathy
- Pleuritis
- Pericarditis
- Myopathy
- Pancreatitis
Prognosis
- The prognosis of DRESS syndrome is generally good.
- The case-fatality rate of DRESS syndrome is approximately 10%.