title: DRESS syndrome induced by acenocoumarol with tolerance to warfarin and dabigatran: a case report.
abstract: Drug reaction with eosinophlia and systemic symptoms (DRESS) syndrome describes a severe medication-induced adverse reaction, which shows skin, blood and solid-organ features. Up to 50 drugs have been described to cause DRESS. The main responsible drugs are carbamazepine and allopurinol. There are no previous reports associated with acenocoumarol. A 85-year-old white male, who was treated with acenocoumarol for the prevention of venous thromboembolism due to atrial fibrillation, presented 6 weeks later a maculopapular exanthema of the trunk and limbs as well as purple lesions and blisters on distal parts of his legs. Elevated creatinine, glucose, urea, International Normalized Ratio, gamma-glutamyl-transpeptidase (GGT) and eosinophilia levels were observed. Acenocoumarol was removed and enoxaparine, systemic corticosteroids, antihistamines were used as treatment with a favorable clinical evolution: 1 month later, the skin lesions had disappeared and laboratory parameters were normalized. Patch tests with warfarin and dabigatran were carried out. Two simple-blind, placebo-controlled oral challenges with warfarin and dabigatran were performed. Patch tests were negative, and single-blind, placebo-controlled oral challenges with warfarin and dabigatran were achieved without immediate or delayed reactions. We firstly describe a DRESS syndrome induced by acenocoumarol. Patch test was useful to assess alternative therapies. Tolerance to other anticoagulants (warfarin and dabigatran) was demonstrated.
authors.affiliation: Allergy Unit, Virgen del Rocío University Hospital, Seville, Spain. macpisa@gmail.com
authors.forename: Macarena
authors.initials: M
authors.lastname: Piñero-Saavedra
authors.forename: Manuel Prados
authors.initials: MP
authors.lastname: Castaño
authors.forename: Maria Ortega
authors.initials: MO
authors.lastname: Camarero
authors.forename: Santiago Leguisamo
authors.initials: SL
authors.lastname: Milla
mesh_terms: D000074:Acenocoumarol / Q000009:adverse effects*; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001562:Benzimidazoles / Q000627:therapeutic use*; D000069604:Dabigatran; D003875:Drug Eruptions / Q000150:complications / Q000209:etiology*; D004802:Eosinophilia / Q000150:complications / Q000209:etiology*; D005076:Exanthema / Q000139:chemically induced; D006801:Humans; D008297:Male; D054556:Venous Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran; D000074:Acenocoumarol