González-Altamirano DA, De CBE, Muñoz-Hernández OS, Cortés-Rodríguez CO

Language: Spanish
References: 10
Page: 99-104
PDF size: 255.50 Kb.

ABSTRACT

Introduction: DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe idiosyncratic reaction secondary to the administration of a drug, which is characterized by a long latency period (2-8 weeks) and a variety of clinical manifestations, generally fever, skin rash, lymphadenopathy, eosinophilia. Aromatic anticonvulsants (phenytoin, phenobarbital, carbamazepine) and sulfonamides are the most common cause of DRESS syndrome. Worldwide, there is an estimated incidence of 1 in 1,000 to 1 in 10,000 drug exposures and its incidence is 0.4 cases per 1,000,000 inhabitants in the general population. The pathogenesis is not exactly known and it is suggested that it is due to an excess of toxic metabolites caused by genetic or environmental alterations in the pharmacological detoxification pathway. In an effort to define the diagnosis of the syndrome, the RegiSCAR (Registry of Severe Cutaneous Adverse Reaction) scoring system was developed, it classifies DRESS syndrome cases as "not a case," "possible," "probable" or "definitive". The first step in treating DRESS syndrome is to discontinue the medication associated with its onset. All patients in whom there is a clinical suspicion of DRESS syndrome should be evaluated according to the criteria of the RegiSCAR scale, and the existence and severity of the involvement of internal organs should be evaluated, in addition to the physical examination, by means of laboratory studies. and cabinet. Patients with a severe clinical picture should be managed with systemic steroids. Mortality reported in patients with DRESS ranges from 3.7 to 10%. Case report: 39-year-old woman who, after taking an anticonvulsant drug, begins with a systemic reaction that merits attention in a general hospital with clinical parameters and a subsequent approach to invasive studies (biopsy) is classified as a definitive case, due to the severity of the condition Systemic steroids were started with significant clinical improvement 48 hours after the start of treatment, later it was decided to discharge them to the home with close monitoring.

REFERENCES

1. Choudhary S, McLeod M, Torchia D, Romanelli P. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome. J Clin Aesthet Dermatol. 2013;6(6):31-37.

2. Muciño-Bermejo J, Díaz de León-Ponce M, Briones-Vega CG, Guerrero-Hernández A, Sandoval-Ayala OI, Sáenz-Coronado AG, et al. Síndrome de DRESS. Reporte de un caso clínico. Revista Médica del Instituto Mexicano del Seguro Social. 2013;51(3):330-335. Disponible en: https://www.redalyc.org/articulo.oa?id=457745489018

3. Walsh SA, Creamer D. Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. Clin Exp Dermatol 2011;36(1):6-11.

4. Bocquet H, Bagot M, Roujeau JC. Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Seminars in Cutaneous Medicine and Surgery. 1996;15(4):250-257. Available in: https://europepmc.org/article/med/9069593

5. Um SJ, Lee SK, Kim YH, Kim KH, Son CH, Roh MS, et al. Clinical Features of Drug-Induced Hypersensitivity Syndrome in 38 Patients. J Investig Allergol Clin Immunol. 2010;20(7):556-562. Available in: http://www.jiaci.org/issues/vol20issue7/3.pdf

6. Chiou CC, Yang LC, Hung SI, Chang YC, Kuo TT, Ho HC, et al. Clinicopathological features and prognosis of drug rash with eosinophilia and systemic symptoms: a study of 30 cases in Taiwan. J Eur Acad Dermatol Venereol 2008;22(9):1044-1049.

7. Magliano J, Álvarez M, Salmentón M. Síndrome DRESS por carbamazepina. Arch. Pediatr. Urug. 2009;80(4):291-295.

8. Quintero-Martínez DC, Flores-Arizmendi RA, Torres-Rodríguez L. Síndrome de DRESS asociado con carbamazepina. Bol Med Hosp Infant Mex. 2015;72(2):118-123.

9. Cacoub P, Musette P, Descamps V, Meyer O, Speirs C, Finzi L, et al. The DRESS syndrome: a literature review. Am J Med. 2011;124(7):588-597.

10. Begon E, Roujeau JC. Drug hypersensitivity syndrome: DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms). Ann Dermatol Venereol. 2004;131(3):293-297.