View source for Drug rash with eosinophilia and systemic symptoms syndrome

==Background==
*Known as ''DRESS'' syndrome
*A severe adverse drug reaction 
*Usually begins within 8 weeks of starting a new drug
*8-10% mortality
*Previously known as ''[[Dilantin]] Hypersensitivity Syndrome'' or ''Anti-convulsant hypersensitivity syndrome''
*However, many other medications, particularly antibiotics
*A virus-drug interaction with HHV-6, HHV-7, EBV, and CMV may be a form of pathogenesis as well<ref>Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome. Sonal Choudhary, Michael McLeod, Daniele Torchia, Paolo Romanelli. J Clin Aesthet Dermatol. 2013 Jun; 6(6): 31–37.</ref>

===Associated Drugs===
*Most common
**[[Phenytoin]]
**[[Phenobarbital]]
**[[Carbamazepine]]
**[[Allopurinol]]
**Sulfa drugs
*Others
**[[NSAIDS]]
**Anti-retrovirals
**[[ACE inhibitors]]
**[[Calcium-channel blockers]]
**Atypical [[antipsychotics]] ([[ziprasidone]], [[olanzapine]], etc.)<ref>Herman AO. Antipsychotic Linked to Potentially Fatal Skin Reaction. Physician's First Watch. Dec 12, 2014. http://www.jwatch.org/fw109630/2014/12/12/antipsychotic-linked-potentially-fatal-skin-reaction?query=pfw&jwd=000013530619&jspc=.</ref>
**Other [[antibiotics]]

==Clinical Features==
[[File:PMC4021248 aair-6-270-g001.png|thumb|DRESS induced by chloral hydrate: (A) Generalized edematous features & systemic morbilliform rash (B) Sternostomy wounds (C) hepatosplenomegaly.]]
[[File:PMC3233373 ijgm-4-789f3.png|thumb|Allopurinol causing DRESS: Rash spreading symmetrically to the lower extremities (non-blanching).]]
[[File:PMC3894017 JFMPC-2-83-g001.png|thumb|DRESS due to anti-TB medication.]]
*[[Fever]] and [[rash]] (varying; may resemble [[SJS]]) are typically first signs
**Usually urticarial, maculopapular eruption
**In some cases vesicles, bullae, pustules, purpura, target lesions, facial edema, cheilitis, erythroderma
*+/- [[lymphadenopathy]]
*Systemic involvement may manifest as [[hepatitis]], [[pneumonitis]], [[myocarditis]], pericarditis, nephritis, colitis
**Atypical lymphocytes, [[thrombocytopenia]], [[neutropenia]], [[anemia]]
**[[Leukocytosis]] with [[eosinophilia]] in 50-90%, and mononucleosis in 40%<ref>Callot V, Roujeau JC, Bagot M, et al. Drug-induced pseudolymphoma and hypersensitivity syndrome. Two different clinical entities. Arch Dermatol. 1996;132:1315–1321.</ref><ref>Peyriere H, Dereure O, Breton H, et al. Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol. 2006;155:422–428.</ref>

==Differential Diagnosis==
{{Erythematous rash DDX}}

==Evaluation==
===Workup===
*CBC with diff
*BMP
*[[LFTs]]
*Coags
*ESR
*CRP
*[[Viral hepatitis]] panel
*Biopsy

===Diagnosis===
{{Table of severe drug reactions}}

==Management==
*Discontinue suspected drug
*Supportive care: antipyretic, anti-pruritic
*[[parkland formula|Fluid management]] as in [[burn]]
*Systemic [[steroids]] and/or cyclosporin/immunosuppressants in severe cases (controversial)
**Hepatitis, pneumonitis, extensive exfoliative dermatitis
**Other severe systemic manifestations
*Family counseling as possible genetic component

==Disposition==
*Admit

==See Also==
*[[Erythematous rash]]

==External Links==
*[http://emedicine.medscape.com/article/1049474-overview Medscape - Drug Erruptions]
*[http://www.medscape.com/viewarticle/738548_4 The DRESS Syndrome: The Great Clinical Mimicker]

==References==
<references/>
[[Category:Dermatology]]