DRESS syndrome natural history, complications and prognosis
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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.
- 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:
Prognosis
- The prognosis of DRESS syndrome is generally good.
- The case-fatality rate of DRESS syndrome is approximately 10%.