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Phenytoin Induced drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Case Report

Case Reports in Clinical Medicine 2020年第11期9卷 343-353页

作者： Maria Noel Marzano Rodrigues Julia Arriada Cabreira Rony Kafer Nobre Medicine School Catholic University of Pelotas Pelotas Brazil

Background: drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially life-threatening condition. It presents a long prodromal period, extensive rash, fever, lymphadenopathy, hematologic abnormalities (eosinophilia with or without atypical lymphocytosis), and internal organ involvement. Purpose: To describe a case of phenytoin induced DRESS syndrome, presenting diagnostic and management challenges of clinical interest. Methods: The Consensus-based Clinical Case Reporting Guideline Development (CARE) was observed for data analysis in case reports. Case Report: A 22-year-old man, using phenytoin for 60 days, sought medical attention due to fever and maculopapular cutaneous lesions. He presented lymphocytosis with eosinophilia and severe acute hepatitis 24 hours after admission day. Hepatic transaminases returned to reference levels after phenytoin withdrawal, and eosinophilia and cutaneous manifestations did not respond well to systemic steroids. A forearm biopsy showed findings suggestive of severe cutaneous adverse reaction. The patient’s microscopic and clinical characteristics meet all criteria in the scoring systems of Bocquet et al., Registry of Severe Cutaneous Adverse Reaction (RegiSCAR), and Japanese Research Committee on Severe Cutaneous Adverse Reaction (J-SCAR), being highly suggestive of DRESS syndrome very probably caused by phenytoin. The complete remission of symptoms was achieved weeks after admission. Conclusions: DRESS syndrome is a defiant reaction. Clinicians must be aware of potential causative drugs and perform a complete clinical examination using the available resources, including laboratory tests and histopathological assessment. The clinical remission relies on the withdrawal of the culprit drug. Particular attention should be given to the involvement of internal organs.

关键词： drug hypersensitivity syndrome Eosinophilia Anticonvulsants

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Retrospective Analysis of 41 Severe Cutaneous Adverse drugs Reaction Cases

Retrospective Analysis of 41 Severe Cutaneous Adverse Drugs ...

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作者： Tomy Martin 重庆医科大学

学位级别：硕士

Background The objective of this study is to analyze the clinical spectrum of Severe Cutaneous Adverse drug Reactions (SCADRs), and the causative agents at a hospital-based retrospective study for period 6 years.Methods All inpatients patients that consulting for SCADRs at Dermatology and Venereology Department of First Affiliated Hospital of Chong Qing Medical University from January, 2002 to August, 2007 were included in the study. A retrospective analysis of 41 SCADRs cases. Result were analyze with SPSS 13.0 statistical software by using Parametric test (ANOVA , LSD, t test) and nonparametric test (Pearson Chi-Square, Kruskal-Wallis, Mann-Whitney test) for hypothesis testing. Finding was considered statistically significant if the p value drug Reactions (CADRs) cases, total 41 patients were diagnosed with SCADRs, which ED was the higher proportion among others, followed by SJS and TEN. The prevalence ratio of SCADRs was 11.4 per thousand per year. ED, SJS, TEN prevalence were 5.84, 2.78, 2.78 per thousand per year, respectively. SCADRs male : female ratio was 1.9: 1 (27 : 14), the mean onset age were 43.07(SD±20.06), the youngest age was 10 years , the oldest age was 92 years. The most common underlying disease was infection. The most common drugs that induce SCADRs were antibiotic followed by anticonvulsant.Conclusions The result of this study had many similarity to previous studies conducted in China. Infection was the common cause and antibiotic was the common induced drugs.

关键词： severe cutaneous adverse drug reactions drug hypersensitivity syndrome exfoliative dermatitis toxic epidermal necrolysis Steven Johnson syndrome

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