Severe acute hepatitis in the DRESS syndrome: Report of two cases.
The DRESS (drug rash, eosinophilia and systemic symptoms) syndrome, also known as DIHS (drug-induced hypersensitivity syndrome), is a severe idiosyncratic reaction to several drugs, mainly antiepileptics and antibiotics, which can occasionally produce acute liver failure. In this article we present two cases of the DRESS syndrome presenting with severe acute hepatitis, including the first case of DRESS associated with levetiracetam. Although both cases finally resolved with good outcomes, DRESS can lead to acute liver failure and has a bad prognosis when liver damage is present. Rapid diagnosis is crucial since withdrawal of the offending drug is the key of treatment, while the potential role of corticosteroids is discussed.
Institut de Malalties Digestives, Hospital Clínic, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
Sabela
S
Lens
Gonzalo
G
Crespo
Jose A
JA
Carrión
Rosa
R
Miquel
Miquel
M
Navasa
D000208:Acute Disease; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000927:Anticonvulsants / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D004338:Drug Combinations; D004342:Drug Hypersensitivity / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D004802:Eosinophilia / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005944:Glucosamine / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D000077287:Levetiracetam; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives*; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000009:adverse effects*; D013577:Syndrome; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D004338:Drug Combinations; C028423:Salazopyrine; D012460:Sulfasalazine; D000077287:Levetiracetam; D005944:Glucosamine; D010889:Piracetam