[Caso clínico: síndrome de DRESS por hidroxicloroquina].

Background: DRESS syndrome (Drug reaction with eosinophilia and systemic symptoms) is an idiosyncratic reaction characterized by peripheral eosinophilia and systemic symptoms: fever, exanthema, lymphadenopathy, hepatitis, atypical lymphocytes and elevated liver enzymes. The incidence is 1 per 10,000 exposures, mortality 10-20%. Treatment is based on suspension of the suspected drug and steroids. Case report: A 42-year-old male with the following important antecedents. AHF: mother and father with Diabetes Mellitus type 2. APP: Arterial Hypertension, Diabetes Mellitus type 2, and bee sting allergy. Current Condition: He started 8 days after ingestion of hydroxychloroquine for probable SARS-COV-2 infection, with headache, facial and neck edema, desquamative dermatosis on trunk and upper extremities, went to private clinic with torpid evolution sent to third level for increased facial and neck edema, which merited orotracheal intubation, management with intravenous steroids and antihistamines. Labs on admission: Leukocytes 20090, platelets 322 thousand, eosinophilia (5%), elevated liver enzymes and acute kidney injury, fulfilling J-SCAR criteria. The patient was discharged due to adequate evolution with follow-up by Allergy and Clinical Immunology, the patient persists with desquamative lesions after 4 weeks and normalization of laboratory parameters. Conclusions: DRESS is a delayed adverse reaction. It is important the diagnostic presumption and the causal relationship with the drugs due to the high mortality rate.

Antecedentes: El síndrome DRESS (Drug reaction with eosinophilia and systemic symptoms) es una reacción idiosincrática, se caracteriza por eosinofilia perifé- rica y síntomas sistémicos: fiebre, exantema, linfadenopatía, hepatitis, linfocitos atípicos y elevación de enzimas hepáticas. La incidencia es de 1 por cada 10,000 exposiciones, mortalidad de 10 a 20%. El tratamiento se basa en la suspensión del fármaco sospechoso y en la aplicación de esteroides. Reporte de caso: Masculino de 42 años con los siguientes antecedentes de importancia. AHF: madre y padre con Diabetes Mellitus tipo 2. APP: Hipertensión Arterial, Diabetes Mellitus tipo 2, y alergia a picadura de abeja. Padecimiento Actual: Lo inicia posterior a 8 días tras la ingesta de hidroxicloroquina por probable infección por SARS-COV-2, con cefalea, edema facial y de cuello, dermatosis descamativa en tronco y extremidades superiores, acude a clínica particular con evolución tórpida enviado a tercer nivel por aumento de edema facial y cuello, que amerito intubación orotraqueal, manejo con esteroides intravenosos y anti- histamínicos. Laboratorios a su ingreso: Leucocitos 20090, plaquetas 322 mil, eosinofilia (5%), elevación de enzimas hepáticas y lesión renal aguda, cumpliendo criterios J-SCAR. Se egresa por adecuada evolución con seguimiento por Alergia e Inmunología Clínica, el paciente persiste con lesiones descamativas posterior a 4 semanas y normalización de parámetros de laboratorios. Conclusión: DRESS es una reacción adversa retardada. Es importante la presunción diagnóstica y la relación causal con los fármacos por la alta tasa de morta- lidad.

[Correlation of cutaneous reactivity between allergenic extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae with Blomis tropicalis in patients with allergic rinitis and asthma]. / Correlación de reactividad cutánea entre extractos alergénicos de Dermatophagoides pteronyssinus y Dermatophagoides farinae, con Blomia tropicalis en pacientes con rinitis alérgica y asma.

BACKGROUND: There are documented molecular homologies between mites from the same group, but intergroup characteristics are not. Although mites share the same taxonomic order, there are species antigenically distinct. At the present we dont know clearly the differences in cutaneous reactivity among several house dust mites species. OBJETIVE: to estimate the correlation of skin reactivity to Dermatophagoides pteronyssinus and Dermatophagoides farinae antigens with that of Blomia tropicalis in patients with allergic rhinitis and asthma. METHODS: a cross sectional, observational, prolective and interpretive study was performed in patients of both genders, aged 2 to 58 with allergic rhinitis and asthma. All patients underwent skin prick tests with allergenic extracts. RESULTS: One hundred and ten patients were included, with an age average of 24.1 years; 50% were males. There were positive skin tests with mites in 59% of the patients, 24.5% for Blomia t; 10% for D. pteronyssinus plus Blomia t. and 7.29% for D. farinae plus Blomia t. The correlation of the skin reactivity between Dermatophagoides pteronyssinus and Blomia tropicalis (r= 0.36) and between Dermatophagoides farinae and Blomia tropicalis (r= 0.27), was not significant in both cases. CONCLUSIONS: We found that most patients with allergic rhinitis and asthma showed positive skin tests with the mite extracts tested. There is a weak correlation between both species of Dermatophagoides and Blomia tropicalis.