[DRESS as a rare differential diagnosis in eosinophilia, skin rash and acute hepatitis]. / DRESS als seltene Differentialdiagnose bei Eosinophilie, Hautexanthem und akuter Hepatitis.

A 21-year-old female patient presented with fever, pharyngitis, lymphadenopathy and generalized exanthema that had started 2 weeks prior. Allergies were not known, the family and travel history were negative. Due to depression, Duloxetine had been taken for 1.5 years, and due to bipolar disorder, a treatment with Lamotrigine was started four weeks prior but was stopped because of increased transaminase levels. Laboratory findings on admission showed eosinophilia (1.327 /nl), lymphocytosis and acute hepatitis (GOT 428 U/l, GPT 438 U/l) with deranged coagulation. Inflammatory parameters were increased. Ultrasound revealed hepatosplenomegaly with ascites. Acute viral or parasitic infection was excluded serologically. A skin biopsy showed a perivascular inflammatory infiltrate, compatible with a drug reaction. An inflammatory infiltrate was found in the liver biopsy, consistent with drug-induced hepatitis. Cough, dyspnea and pleural effusion occurred. In summary of the findings and with the help of the RegiSCAR-Score, the diagnosis of drug reaction with eosinophilia and systemic symptoms (DRESS) could be made. Under high-dose prednisolone therapy, a gradual decrease of transaminases and reconstitution of liver synthesis could be observed.In patients with eosinophilia, lymphadenopathy, acute hepatitis and generalized exanthema, DRESS is a rare but-due to its potentially life-threatening consequences-important differential diagnosis. The most important measure is to stop the suspected inducing medication immediately. Severe cases should be treated with high-dose systemic corticosteroids.

Feasibility, acceptance, safety, and effectiveness of antibiotic therapy as alternative treatment approach to appendectomy in uncomplicated acute appendicitis.

PURPOSE: Based on results from randomized controlled trials, there is an increasing discussion if antibiotic treatment is an equivalent therapeutic approach to appendectomy in uncomplicated acute appendicitis. This observational prospective study evaluates its feasibility, safety, and effectiveness in clinical practice. METHODS: The study included all consecutive adults treated for acute appendicitis over an 18-month period in one hospital. Patients receiving antibiotics were compared to those treated surgically. Follow-up comprised 1 year. The primary endpoint was treatment success, defined as no secondary appendectomy during follow-up (antibiotic group) or successful appendectomy (primary surgical group). Secondary endpoints were complications, duration of hospital stay, pain intensity, and length of absence from work. RESULTS: 54/124 (43.6%) patients were primarily treated with antibiotics and 70/124 (56.4%) surgically. Treatment success at 1 year was 77.1% (95%-CI 62.8-88%) for antibiotic and 100% for surgical treatment. Complications were non-significantly less frequent both among all patients treated with antibiotics and among patients undergoing secondary appendectomy compared to patients undergoing primary appendectomy (20.8% vs. 27.1% and 9.1% vs. 27.1%). The initial hospital stay was significantly shorter in the antibiotic group (mean 3.6 vs. 4.8 days, median 3 days, p = 0.03). After 1 year, the cumulative hospital stay was not different between groups. CONCLUSIONS: Appendectomy remains the most effective treatment for the definitive cure of acute appendicitis. However, antibiotic therapy can be a safe alternative approach for selected patients with uncomplicated acute appendicitis. TRIAL REGISTRATION: DRKS00010401.

Antibiotic therapy for acute uncomplicated appendicitis: a systematic review and meta-analysis.

PURPOSE: Appendectomy has been the gold standard for every form of appendicitis. In recent years, though, it has repeatedly been claimed that for acute uncomplicated appendicitis, antibiotic therapy can be an equivalent treatment. The aim of this meta-analysis was to determine if antibiotic therapy is a safe and effective alternative to appendectomy for acute uncomplicated appendicitis. METHODS: In a systematic literature review, relevant databases were searched for randomized studies comparing appendectomy with antibiotic treatment for uncomplicated acute appendicitis. Two independent reviewers performed study selection and data extraction. The primary endpoint was the successful treatment of appendicitis. Secondary endpoints were pain intensity, duration of hospitalization, absence from work, and the incidence of complications. RESULTS: Five randomized controlled studies (n = 1430 patients) fulfilled the inclusion criteria. Of the 727 patients treated initially with antibiotics, 272 (37.4%) underwent secondary appendectomy within 1 year (treatment effectiveness: 62.6% compared to 96.3% in the surgical group, RR 0.65, 95% CI 0.55-0.76, p < 0.00001). Neither duration of hospital stay (MD 0.11 days, 95% CI: - 0.22-0.43, p = 0.53) nor the probability of complication-free treatment (RR 1.08, 95% CI: 0.97-1.22, p = 0.16) were significantly different between the two treatments. Absence from work was significantly shorter in the antibiotic group (MD - 2.49 days, 95% CI: - 4.59-- 0.40, p = 0.02). CONCLUSIONS: This meta-analysis shows that appendectomy is more effective than antibiotic therapy for definitive cure of acute uncomplicated appendicitis. However, since the incidence of complications does not differ between the two treatments, antibiotic therapy might be a reasonable alternative for selected patients.