Drug reaction with eosinophilia and systemic symptoms: observations from a tertiary care institution.
BACKGROUND
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction which can mimic a viral infection, an autoimmune disease or a neoplastic disease.


OBJECTIVE
To study the clinical and epidemiological aspects of DRESS and to identify the precipitating drugs.


METHODS
All patients admitted to the dermatology ward of our tertiary care hospital from 1 st October 2010 to 30 th September 2013 with probable or definite DRESS as per the RegiSCAR scoring system were included in this prospective study. The clinical manifestations observed in the study population were studied and the common offending drugs were identified.


RESULTS
During the 3 year study period, 26 patients fulfilled criteria for probable or definite DRESS. In more than 50% of cases, the culprit drug was phenytoin. Most common symptoms observed were fever, rash and facial edema. Liver was the most common internal organ affected. Most of the patients responded to withdrawal of the drug and administration of steroids for 3-6 weeks. One patient with dapsone-induced DRESS died.


CONCLUSIONS
Intense facial erythema and edema and an elevated eosinophil count were not found to be bad prognostic factors. In most instances the flare ups during the course of the disease could be managed with a slower tapering of steroids. More prospective studies on DRESS are required to assess the prognostic factors and to formulate better diagnostic criteria.
Department of Dermatology and Venereology, Govt Medical College, Kozhikode, Kerala, India.
Sarita
S
Sasidharanpillai
Najeeba
N
Riyaz
Uma
U
Rajan
Manikoth P
MP
Binitha
Anza
A
Khader
Olasseri K Reena
OK
Mariyath
Rajiv
R
John
Jayasree
J
Puravoor
D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003622:Dapsone / Q000009:adverse effects*; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000209:etiology*; D004804:Eosinophils / Q000166:cytology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000009:adverse effects*; D011446:Prospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
D000890:Anti-Infective Agents; D000927:Anticonvulsants; D010672:Phenytoin; D003622:Dapsone