ABSTRACT
Drug reactions with eosinophilia and systemic symptom (DRESS) are a severe drug eruption, which is characterized by fever, rash, lymphadenopathy, hematological system abnormalities and involvement of internal organs.It also has such clinical characteristics as delayed onset, relapsing symptoms and reactivation of human herpesvi-ruses.The clinical characteristics of DRESS make it different from other drug reactions, with high clinical heterogeneity, variability and unpredictability.DRESS in children has some unique characteristics that are different from adults, such as culprit drugs, rash characteristics, and involved systems and organs.Moreover, the course of disease is shorter, the severity is milder, the morbidity and mortality are lower, and the prognosis is better compared with adults.In this paper, the clinical characteristics and progress in diagnosis and treatment of DRESS in children are reviewed.
ABSTRACT
Objective To analyze the diagnose and treatment of drug-induced hypersensitivity syndrome (DIHS) in children.MethodsThe clinical data from one case of highly suspected DIHS were retrospectively analyzed. The related literatures were reviewed.ResultsA 22-month-old male child with severe pneumonia, after treated with vancomycin, suffered with high fever and skin rash combined with hepatic lesion and hematological system disorder. After withdrawal of vancomycin and then treatment with the combination of high-dose methylprednisolone and intravenous immunoglobulin, the clinical symptoms were gradually relieved in 24 hours. The child was improved and discharged on 17th day.ConclusionThe child has the characteristics of DIHS which is highly suspected to be caused by vancomycin.
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Objective To investigate the pharmacoepidemiologic features of drug-induced hypersensitivity syndrome (DHS) and improve the recognition of its particularity.Methods The clinical data of 28 patients with DHS were retrospectively analyzed and summarized.Results Of 28 DHS patients,the suspected drugs were allopurinol in 17 cases,anti-epileptic drugs in 4 cases,antiuberculotic drugs in 3 cases and non-steroidal anti-inflammatory drugs in 4 cases.The earliest symptoms of DHS were skin rash (89.3 ％) and fever(85.7 ％),secondly liver function damaged(75.0％),which may be accompanied by mucosa,eye,genital damage (53.6％),eosinophilia (32.1％),renal impairment (17.9％),even multiple organ failure and death.Conclusion DHS should be on the alert when rash,repeated fever and visceral lesion occurred in a patient,without good therapeutic efficacy through ordinary anti-anaphylaxis and anti-infective therapy,as well as with the above medication history.
ABSTRACT
A 45-year-old man, on carbamazepine for the past 3 months, was referred as a case of atypical measles. On examination, he had high-grade fever, generalized itchy rash, cough, vomiting and jaundice. A provisional diagnosis of drug hypersensitivity syndrome to carbamazepine was made with a differential diagnosis of viral exanthema with systemic complications. Laboratory investigations revealed leukocytosis with eosnophilia and elevated liver enzymes. Real-time multiplex polymerase chain reaction (PCR) on throat swab and blood was suggestive of human herpesvirus-6 (HHV-6). Measles was ruled out by PCR and serology. The diagnosis of drug-induced hypersensitivity syndrome (DIHS) was confirmed, which could explain all the features manifested by the patient. HHV-6 infects almost all humans by age 2 years. It infects and replicates in CD4 T lymphocytes and establishes latency in human peripheral blood monocytes or macrophages and early bone marrow progenitors. In DIHS, allergic reaction to the causative drug stimulates T cells, which leads to reactivation of the herpesvirus genome. DIHS is treated by withdrawal of the culprit drug and administration of systemic steroids. Our patient responded well to steroids and HHV-6 was negative on repeat real-time multiplex PCR at the end of treatment.
ABSTRACT
BACKGROUND: Because more severe patients tend to be admitted to the Department of Internal Medicine, drug-induced hypersensitivity syndrome may be underestimated by the dermatological evaluation of only in-patients. OBJECTIVE: The purpose of this study was designed to compare the clinical features of in-patients with drug-induced hypersensitivity syndrome in the Departments of Dermatology and Internal Medicine. METHODS: Between January 2000 and September 2010, we retrospectively reviewed the medical records of 10 in-patients in the Department of Dermatology and 11 in-patients in the Department of Internal Medicine in drug-induced hypersensitivity syndrome. RESULTS: The average age of onset was older in the internal medicine group than the dermatology group. The most common causative agent in the dermatology group was carbamazepine. The most common causative agents in the internal medicine group were carbamazepine, anti-tuberculosis, and allopruinol. The average latent period was longer in the internal medicine group than the dermatology group. The most common morphological feature in the dermatology group was maculopapular eruption, but in the internal medicine group was exfoliative dermatitis. Abnormal laboratory findings in drug-induced hypersensitivity syndrome were more severe in the internal medicine group than the dermatology group. The average treatment period was longer in the internal medicine group than the dermatology group. CONCLUSION: Our study suggests that in-patients of the internal medicine in drug-induced hypersensitivity syndrome are more severe than in-patients ofthe dermatology. Therefore, it is important that dermatologists recognize the concept of this syndrome much more widely.
Subject(s)
Humans , Age of Onset , Carbamazepine , Dermatitis, Exfoliative , Dermatology , Hypersensitivity , Internal Medicine , Medical Records , Retrospective StudiesABSTRACT
Drug-induced hypersensitivity syndrome is a rare, but severe, life-threatening disease with multiorgan failure. Aromatic antiepileptic drugs are frequent causes of this syndrome. The association of the human herpes virus-6 has been recently reported in patients with drug-induced hypersensitivity syndrome. We report two patients who were diagnosed as having antituberculosis drug-induced hypersensitivity syndrome based on clinical course and laboratory data. In addition, human herpes virus-6 DNA was detected by polymerase chain reaction in peripheral blood mononuclear cells and the serum. There was a favorable outcome after discontinuation of the causative drug, plus corticosteroid therapy. After the treatment, human herpes virus-6 DNA was not detected by polymerase chain reaction. This is the first report of antituberculosis drug-induced hypersensitivity syndrome associated with reactivation of human herpes virus-6.