title: Acute Liver Failure/Injury Related to Drug Reaction With Eosinophilia and Systemic Symptoms: Outcomes and Prognostic Factors.
abstract: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare severe adverse drug-induced reaction with multiorgan involvement. The outcome and prediction of those patients who develop severe acute liver injury (sALI) or acute liver failure (ALF) remain little known.
  
  
  
  A multicenter retrospective study of patients admitted with a diagnosis of DRESS-related sALI or ALF. Histological review was performed on liver core biopsies from native livers.
  
  
  
  Sixteen patients (11 women, 5 men; mean age, 39±17.2 years) were classified as having definite (n=13) or probable (n=3) DRESS. At admission, 3 patients had hepatic encephalopathy; median levels of prothrombin time, INR, and total bilirubin were, respectively, 33% (Q1-Q3, 21-41), 2.74 (1.98-4.50), and 94 μmol/L (Q1-Q3, 39.5-243.5). Nine patients received corticosteroid therapy. Overall, 9 patients improved spontaneously and 7 worsened (liver transplantation [LT] (n=5), deceased (n=2)). Transplantation-free and post-LT survival was 56% and 60%, respectively. After LT, DRESS recurrence was observed in 3 of 5 patients. Systemic corticosteroid therapy was not significantly associated with a clinical improvement. In the multivariate analysis, factor V level less than 40% at day 0 and factor V levels of 40% or greater at admission but decreasing at day 2 were associated with worse outcome. Pathological findings (n=7) revealed atypical lymphoid infiltrates, Kupffer cell hyperplasia with erythrophagocytosis, and an inconstant presence of eosinophils.
  
  
  
  The spontaneous prognosis of patients with sALI/ALF due to DRESS is poor and was not improved by corticosteroid therapy. Histology is helpful to establish diagnosis. Dynamic variables regarding factor V values are predictive of a poor outcome.
authors.affiliation: 1 APHP Hôpital Paul-Brousse, Centre Hépato-Biliaire Villejuif, France. 2 INSERM, Unité 1193, Univ Paris-Saclay, Villejuif, France. 3 Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France. 4 DHU Hepatinov, Villejuif, France. 5 Department of Anatomo-Pathology, APHP Hôpital Bicêtre, Le Kremlin-Bicêtre, France. 6 Department of Liver Surgery and Transplantation, Hôpital de Hautepierre, Strasbourg, France. 7 Department of Hepatology, Liver Intensive Care, APHP Hôpital Beaujon, Clichy, France. 8 Department of Dermatology, APHP Hôpital Henri Mondor, Créteil, France. 9 Department of Dermatology, Hôpital André Mignot, Le Chesnay, France. 10 Department of Liver Surgery, APHP Hôpital Henri Mondor, Créteil, France. 11 Intensive Care Unit, APHP Hôpital Henri Mondor, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichai
authors.forename: Astrid
authors.initials: A
authors.lastname: Laurent-Bellue
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.forename: David
authors.initials: D
authors.lastname: Moreau
authors.forename: Camille
authors.initials: C
authors.lastname: Besch
authors.forename: Claire
authors.initials: C
authors.lastname: Francoz
authors.forename: Laurence
authors.initials: L
authors.lastname: Valeyrie-Allanore
authors.forename: Sylvie Roussin
authors.initials: SR
authors.lastname: Bretagne
authors.forename: Marc
authors.initials: M
authors.lastname: Boudon
authors.forename: Teresa Maria
authors.initials: TM
authors.lastname: Antonini
authors.forename: Florent
authors.initials: F
authors.lastname: Artru
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pittau
authors.forename: Olivier
authors.initials: O
authors.lastname: Roux
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Eric
authors.initials: E
authors.lastname: Levesque
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.forename: Catherine
authors.initials: C
authors.lastname: Guettier
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D063926:Drug Hypersensitivity Syndrome / Q000150:complications*; D004802:Eosinophilia / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D017582:Renal Replacement Therapy / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult