Drug reaction with eosinophilia and systemic symptoms: is cutaneous phenotype a prognostic marker for outcome? A review of clinicopathological features of 27 cases

S. Walsh*, Salvador Diaz-Cano, Elisabeth Higgins, Rachael Morris-Jones, Saqib Bashir, W. Bernal, Daniel Creamer

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    99 Citations (Scopus)

    Abstract

    Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) describes a heterogeneous group of severe adverse reactions to medications. The cutaneous phenotype has a number of guises, accompanied by a variety of systemic features including fever, haematological abnormalities and visceral involvement, most commonly the liver. Clinical markers of prognosis have not been identified.

    Objectives: To assess the cutaneous signs and dermatopathological features of DRESS in order to identify potential prognostic markers.

    Methods: We reviewed the clinical features, dermatopathology and outcomes of 27 consecutive cases of DRESS presenting to a single unit.

    Results: Four distinct patterns of cutaneous involvement were identified: an urticated papular exanthem (13/27 patients), a morbilliform erythema (three of 27), an exfoliative erythroderma (three of 27) and an erythema multiforme-like (EM-like) reaction consisting of atypical targets (eight of 27). All patients mounted a fever, most developed lymphadenopathy (24/27) and peripheral eosinophilia (25/27) and the most common organ involved was the liver (27/27). Review of the dermatopathic features of patients with DRESS demonstrated a superficial spongiotic dermatitis in the majority of cases (16/27). A smaller number of cases showed basal cell vacuolar degeneration and necrotic keratinocytes (nine of 27). The patients with these biopsy findings more commonly had an EM-like cutaneous phenotype, and more severe hepatic involvement. Three patients died, two following failed liver transplants.

    Conclusions: Our series is the first in which a detailed dermatological assessment has been made of consecutive patients presenting with DRESS, and the largest U. K. series to date. Our results suggest a possible prognostic role of the cutaneous and dermatopathic findings in DRESS in predicting the severity of visceral involvement in this syndrome.

    Original languageEnglish
    Pages (from-to)391-401
    Number of pages11
    JournalBritish Journal of Dermatology
    Volume168
    Issue number2
    DOIs
    Publication statusPublished - Feb 2013

    Keywords

    • TOXIC EPIDERMAL NECROLYSIS
    • HYPERSENSITIVITY-SYNDROME
    • DRESS SYNDROME
    • SEVERITY
    • HISTOPATHOLOGY
    • FAILURE
    • RASH

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