title: Liver injury in patients with DRESS: A clinical study of 72 cases.
abstract: BACKGROUND
  Drug reaction with eosinophilia and systemic symptoms (DRESS) is a syndrome involving multiple systems. Liver injury is the most common visceral manifestation.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the types of liver injury and factors associated with DRESS.
  
  
  METHODS
  A retrospective cohort study was conducted in Taiwan using a DRESS database compiled from December 2000 to March 2013.
  
  
  RESULTS
  Seventy-two cases were included in this study. Among them, 62 (86.1%) cases involved liver injury, 6 of which (9.7%) were liver injury before skin presentation. The distribution of liver injury patterns at initial presentation was 23 cholestatic type (37.1%), 17 mixed type (27.4%), and 12 hepatocellular type (19.4%). Patients with hepatocellular-type injuries were younger, with a median age of 31.5 (P = .044). Individuals with liver function results more than 10 times the upper limit were more likely to have fever (P = .026), took more time to recover, and had fewer eosinophils in the dermis (P = .002).
  
  
  CONCLUSIONS
  The study was a retrospective cohort study with limited cases.
  
  
  CONCLUSIONS
  Liver injury is common in DRESS and frequently associated with atypical lymphocytosis. The cholestatic type is the most common type. Patients with cholestatic-type injuries were older and more frequently had interface changes in skin pathology.
authors: Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: I-Chun
authors: IC
authors: Lin
authors: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Hung-Chih
authors: HC
authors: Yang
authors: Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Carol
authors: C
authors: Strong
authors: Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Che-Wen
authors: CW
authors: Yang
authors: Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Yung-Tsu
authors: YT
authors: Cho
authors: Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Kai-Lung
authors: KL
authors: Chen
authors: Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: chiayu@ntu.edu.tw.
authors: Chia-Yu
authors: CY
authors: Chu
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013624:Taiwan
keywords: drug eruption; drug reaction with eosinophilia and systemic symptoms; drug-induced hypersensitivity syndrome; interface change; liver injury