[Severe drug hypersensitivity reaction (DRESS syndrome) to doxycycline].
BACKGROUND
While many cases of DRESS reaction to minocycline have been described, few of these involve doxycycline.


METHODS
A 59-year-old woman of African origin was repatriated after a journey to Ghana for hyperthermia with infiltrated maculopapular exanthema, facial oedema (no mucosal involvement) and polyadenopathy. Laboratory tests revealed hypereosinophilia, hepatic cytolysis and mononucleosis syndrome. Cutaneous histology was non-specific. The patient had been taking doxycycline as antimalarial prophylaxis for three weeks before the onset of symptoms. DRESS to doxycycline was diagnosed. Patch-tests with doxycycline three months later proved negative. The patient's HLA phenotype was A3/A30 and B39/B42.


CONCLUSIONS
An intrinsic causal relationship with doxycycline was likely in this case (I3). Although patch-test sensitivity and specificity with doxycycline remains unknown in DRESS exploration, a negative result does not necessarily rule out the diagnosis. A number of cases of DRESS to doxycycline have been described recently, possibly as a result of more frequent prescription (malarial prophylaxis, acne). Subjects of African ethnicity or having specific HLA phenotypes are at higher risk of developing drug hypersensitivity.


CONCLUSIONS
This patient is the third case of DRESS to doxycycline described in the literature. The originality of this case lies in the allergological investigation using patch-tests and HLA determination.
Mailhol
C
C
Service de dermatologie, hôpital Purpan, CHU de Toulouse, TSA 40031, 31059 Toulouse cedex 9, France.
Tremeau-Martinage
C
C
Paul
C
C
Godel
A
A
Lamant
L
L
Giordano-Labadie
F
F
D000962:Antimalarials / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D004318:Doxycycline / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D005334:Fever / Q000139:chemically induced*; D020022:Genetic Predisposition to Disease; D005869:Ghana / Q000208:ethnology; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000139:chemically induced*; D008206:Lymphatic Diseases / Q000139:chemically induced*; D008875:Middle Aged; D010328:Patch Tests
D000962:Antimalarials; D006680:HLA Antigens; D004318:Doxycycline