Drug rash with eosinophilia and systemic symptoms syndrome
The drug rash with eosinophilia and systemic symptoms (DRESS) syndrome typically manifests as a skin rash, fever, lymph nodal enlargement with variable internal organ involvement, and represents a hypersensitivity reaction to medication.
Clinical presentation
Clinical presentation can be variable and symptoms may arise from 2 to 8 weeks after initiating the offending drug. Typical clinical features include skin rash, fever, lymph node enlargement, and internal organ involvement. In terms of internal organ involvement, it most commonly involves the liver followed by the kidneys and lungs.
Serum eosinophils are often elevated, i.e. eosinophilia .
Pathology
The pathophysiology of DRESS syndrome is not well known. Many drugs have been implicated as precipitants of this syndrome, including:
- anticonvulsants
- sulfonamides
- dapsone
- allopurinol
- minocycline
- gold salts
Radiographic features
CT
A CT chest is often non-specific but may show diffuse multifocal infiltrative opacification .
Treatment and prognosis
The prognosis can be variable but may carry a mortality of up to ~10% in patients with multiorgan involvement. Withdrawal of the causative drug and steroid therapy has traditionally been the mainstays of successful treatment.
History and etymology
It was first described in 1996 by Bocquet et al.
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