DRESS syndrome with autoimmune hepatitis from strontium ranelate.
Strontium ranelate, which is used for postmenopausal osteoporosis, has been associated with drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, a severe, acute, potentially fatal, multisystem adverse drug reaction characterized by skin rash, fever, hematological abnormalities, and lymphadenopathy with involvement of several internal organs. We report the case of a woman who developed DRESS syndrome with a generalized maculopapular rash, eosinophilia, dyspnea, bilateral cervical lymphadenopathy, and reactivation of Epstein-Barr virus (EBV) with liver damage 3 weeks after administration of strontium ranelate for postmenopausal osteoporosis. Approximately 6 months after total remission of cutaneous symptoms, the patient developed autoimmune hepatitis. This case confirms that strontium ranelate should be considered as a possible factor in the etiopathology of DRESS syndrome as well as in the subsequent development of autoimmune hepatitis. The possibility of developing autoimmune hepatitis as a part of DRESS syndrome related to strontium ranelate use can occur months after the acute episode.
Institute of Dermatology and Venereology, University of Trieste, Italy.
Nicola
N
di Meo
Institute of Dermatology and Venereology, University of Trieste, Italy.
Nicoletta
N
Gubertini
Liver Research Center, University of Trieste, Italy.
Lory
L
Crocè
Liver Research Center, University of Trieste, Italy.
Claudio
C
Tiribelli
Institute of Dermatology and Venereology, University of Trieste, Italy.
Giusto
G
Trevisan
D061605:Administration, Intravenous; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D019693:Hepatitis, Autoimmune / Q000175:diagnosis*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008111:Liver Function Tests / Q000379:methods; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D012867:Skin / Q000473:pathology*; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D013876:Thiophenes; C081587:strontium ranelate; D008775:Methylprednisolone