Ten cases of drug reaction with eosinophilia and systemic symptoms (DRESS) treated with pulsed intravenous methylprednisolone

TY - JOUR

T1 - Ten cases of drug reaction with eosinophilia and systemic symptoms (DRESS) treated with pulsed intravenous methylprednisolone

AU - Natkunarajah, Janakan

AU - Goolamali, Sacha

AU - Craythorne, Emma

AU - Benton, Emma

AU - Smith, Catherine

AU - Morris-Jones, Rachael

AU - Wendon, Julia

AU - Higgins, Elisabeth

AU - Creamer, Daniel

PY - 2011/4/30

Y1 - 2011/4/30

N2 - Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, life-threatening, drug-induced illness characterised by a widespread polymorphic eruption, fever and multivisceral involvement. There is little published on the management of DRESS. Prompt recognition and withdrawal of the causative drug is essential, along with supportive treatment. However, the condition commonly progresses despite these measures. Oral corticosteroids are usually given but the response can be suboptimal and result in a prolonged exposure to systemic glucocorticoid. We conducted a prospective single-centre study to determine the efficacy of pulsed intravenous methylprednisolone followed by a short reducing course of oral prednisolone in ten patients with confirmed DRESS. Rash and fever responded rapidly to methylprednisolone in all patients. Compared to pre-treatment assessments, there was a significant reduction in eosinophil count at day 14 and AST level at day 90 post-treatment. One patient developed acute hepatic failure, necessitating a liver transplant, and died 4 months later. In the immediate post-treatment phase, 1 patient developed type 1 diabetes and 1 patient developed a corticosteroid-induced psychosis. Long-term follow-up on 8/10 revealed all patients to be well, although one patient had persistent pruritus. An aggressive corticosteroid regimen in the management of DRESS is associated with good clinical outcome and acceptable tolerance.

AB - Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, life-threatening, drug-induced illness characterised by a widespread polymorphic eruption, fever and multivisceral involvement. There is little published on the management of DRESS. Prompt recognition and withdrawal of the causative drug is essential, along with supportive treatment. However, the condition commonly progresses despite these measures. Oral corticosteroids are usually given but the response can be suboptimal and result in a prolonged exposure to systemic glucocorticoid. We conducted a prospective single-centre study to determine the efficacy of pulsed intravenous methylprednisolone followed by a short reducing course of oral prednisolone in ten patients with confirmed DRESS. Rash and fever responded rapidly to methylprednisolone in all patients. Compared to pre-treatment assessments, there was a significant reduction in eosinophil count at day 14 and AST level at day 90 post-treatment. One patient developed acute hepatic failure, necessitating a liver transplant, and died 4 months later. In the immediate post-treatment phase, 1 patient developed type 1 diabetes and 1 patient developed a corticosteroid-induced psychosis. Long-term follow-up on 8/10 revealed all patients to be well, although one patient had persistent pruritus. An aggressive corticosteroid regimen in the management of DRESS is associated with good clinical outcome and acceptable tolerance.

KW - Administration, Oral

KW - Adult

KW - Dose-Response Relationship, Drug

KW - Drug Eruptions

KW - Eosinophilia

KW - Exanthema

KW - Female

KW - Follow-Up Studies

KW - Glucocorticoids

KW - Humans

KW - Infusions, Intravenous

KW - Leukocyte Count

KW - Male

KW - Methylprednisolone

KW - Middle Aged

KW - Prednisolone

KW - Prospective Studies

KW - Syndrome

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1684/ejd.2011.1300

DO - 10.1684/ejd.2011.1300

M3 - Article

C2 - 21527371

VL - 21

SP - 385

EP - 391

JO - European Journal of Dermatology

JF - European Journal of Dermatology

IS - 3

ER -