Drug reaction with eosinophilia and systemic symptoms: a retrospective study of 60 cases.
OBJECTIVE
To investigate the clinical and pathologic features of patients with drug reaction with eosinophilia and systemic symptoms (DRESS) in Taiwan.


METHODS
Case series and retrospective analysis.


METHODS
A medical referral center in Northern Taiwan.


METHODS
Sixty cases of DRESS occurring from June 1998 to May 2008.


METHODS
Clinical characteristics for specific drugs and important prognostic factors in DRESS.


RESULTS
Patients ranged in age from 6 to 90 years (mean age, 51 years). The female to male ratio was 1.3 to 1. The most common culprit drugs were allopurinol, phenytoin, and dapsone. Exanthematous eruption was the most common skin manifestation, but purpurae and blisters were also observed. Hepatic (80%), renal (40%), and pulmonary (33%) involvement were also common. The overall mortality rate was 10%. Allopurinol-induced DRESS was characterized by preceding chronic renal insufficiency and frequent renal involvement. Pancytopenia indicated a poor prognosis.


CONCLUSIONS
Drug reaction with eosinophilia and systemic symptoms has a variable clinical presentation, and its definition requires clarification. It may be a heterogeneous syndrome with some particular patterns related to different drugs. Early diagnosis and prompt discontinuation of offending drug regimens are essential.
Chen
Yi-Chun
YC
Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Chiu
Hsien-Ching
HC
Chu
Chia-Yu
CY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000009:adverse effects*; D000890:Anti-Infective Agents / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D002648:Child; D003622:Dapsone / Q000009:adverse effects*; D003875:Drug Eruptions / Q000150:complications* / Q000453:epidemiology; D004802:Eosinophilia / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology; D005260:Female; D006074:Gout Suppressants / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010198:Pancytopenia / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology; D010672:Phenytoin / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
D000890:Anti-Infective Agents; D000927:Anticonvulsants; D006074:Gout Suppressants; D010672:Phenytoin; D000493:Allopurinol; D003622:Dapsone