PA Medical News about Drug Hypersensitivity DRESS

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Severe pruritic rash, fever, and malaise
The Clinical Advisor, 11/09/09

McClung A – An 8–year–old white girl sought treatment in the emergency department for a rash that had been present for the previous four days. She complained of severe itching, fatigue, and malaise. Her past medical history included upper–extremity osteomyelitis that had been treated with vancomycin and rifampin for the past month. On examination, the patient was febrile and had confluent erythematous macules and papules on her extremities, trunk, and face with slight edema of her face. Laboratory studies revealed a WBC count of 40,000/microL, 10% of which were eosinophils, and elevated liver function tests (LFTs)...DRESS is a drug hypersensitivity syndrome that must be diagnosed in a timely manner. It is characterized by a severe rash and systemic symptoms. The drugs commonly responsible for DRESS are the aromatic anticonvulsants (phenytoin, carbamazepine, phenobarbital), sulfonamides, nevirapine, and dapsone. The syndrome typically develops two to six weeks after the causative drug is started. Corticosteroids comprise first–line treatment for DRESS. In mild cases, topical steroids can be used, but with life–threatening cases such as this one in which inflammation involves internal organs, systemic steroids are the treatment of choice.