title: Ten cases of drug reaction with eosinophilia and systemic symptoms (DRESS) treated with pulsed intravenous methylprednisolone.
abstract: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, life-threatening, drug-induced illness characterised by a widespread polymorphic eruption, fever and multivisceral involvement. There is little published on the management of DRESS. Prompt recognition and withdrawal of the causative drug is essential, along with supportive treatment. However, the condition commonly progresses despite these measures. Oral corticosteroids are usually given but the response can be suboptimal and result in a prolonged exposure to systemic glucocorticoid. We conducted a prospective single-centre study to determine the efficacy of pulsed intravenous methylprednisolone followed by a short reducing course of oral prednisolone in ten patients with confirmed DRESS. Rash and fever responded rapidly to methylprednisolone in all patients. Compared to pre-treatment assessments, there was a significant reduction in eosinophil count at day 14 and AST level at day 90 post-treatment. One patient developed acute hepatic failure, necessitating a liver transplant, and died 4 months later. In the immediate post-treatment phase, 1 patient developed type 1 diabetes and 1 patient developed a corticosteroid-induced psychosis. Long-term follow-up on 8/10 revealed all patients to be well, although one patient had persistent pruritus. An aggressive corticosteroid regimen in the management of DRESS is associated with good clinical outcome and acceptable tolerance.
authors.affiliation: Department of Dermatology, King's College Hospital, Denmark Hill, London SE5 9RS, UK. janakan@fsmail.net
authors.forename: Janakan
authors.initials: J
authors.lastname: Natkunarajah
authors.forename: Sacha
authors.initials: S
authors.lastname: Goolamali
authors.forename: Emma
authors.initials: E
authors.lastname: Craythorne
authors.forename: Emma
authors.initials: E
authors.lastname: Benton
authors.forename: Catherine
authors.initials: C
authors.lastname: Smith
authors.forename: Rachael
authors.initials: R
authors.lastname: Morris-Jones
authors.forename: Julia
authors.initials: J
authors.lastname: Wendon
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Higgins
authors.forename: Daniel
authors.initials: D
authors.lastname: Creamer
mesh_terms: D000284:Administration, Oral; D000328:Adult; D004305:Dose-Response Relationship, Drug; D003875:Drug Eruptions / Q000150:complications / Q000188:drug therapy*; D004802:Eosinophilia / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D005076:Exanthema / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007958:Leukocyte Count; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D011446:Prospective Studies; D013577:Syndrome; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone; D008775:Methylprednisolone