title: Cardiac involvement in DRESS syndrome.
abstract: OBJECTIVE
  Cardiac involvement in drug rash with eosinophilia and systemic symptoms (DRESS) syndrome varies considerably between 4% and 21%. Here we present our case and review literatures for its diagnosis and management. An algorithm for diagnosis of cardiac involvement in DRESS syndrome is proposed in this article.
  
  
  METHODS
  Data regarding DRESS-associated myocarditis and eosinophilic myocarditis were gather primarily from MEDLINE database.
  
  
  RESULTS
  DRESS syndrome is a hypersensitivity reaction which is due to massive T cell stimulation resulting in cytotoxicity and eosinophil activation and recruitment. It is characterized by fever, morbilliform rash, and various systemic symptoms, in particular hepatitis. Hypersensitivity myocarditis (acute eosinophilic myocarditis) which is typically related to a drug reaction can lead to acute necrotizing eosinophilic myocarditis, cardiac thrombosis and fibrotic stage. Cardiac symptoms range from no symptoms to cardiogenic shock. Diagnosis is based on history, clinical findings, cardiac biomarkers and cardiac imaging techniques. Endomyocardial biopsy is done in a minority of patients for definite diagnosis. If suspected, drug discontinuation and suppression of immune reactions are the first therapies. Corticosteroids are the cornerstone of systemic treatments and should be initiated at the time of diagnosis of DRESS syndrome. Additional therapy and ventricular assist devices could be considered in refractory cases.
  
  
  CONCLUSIONS
  According to its high morbidity and mortality, patients with DRESS syndrome should be carefully monitored or screened for cardiac involvement. Multidisciplinary care is important for a successful treatment outcome.
authors.affiliation: Department of Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand.
authors.forename: Tomon
authors.initials: T
authors.lastname: Thongsri
authors.affiliation: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Leena
authors.initials: L
authors.lastname: Chularojanamontri
authors.affiliation: ADR-AC GmbH, Holligenstr 91, 3008 Bern Switzerland.
authors.forename: Werner J
authors.initials: WJ
authors.lastname: Pichler
mesh_terms: D063926:Drug Hypersensitivity Syndrome / Q000150:complications* / Q000503:physiopathology*; D006331:Heart Diseases / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged