We
had an interesting case on the lead-up to Christmas. A patient with increasing
eosinophilia…. What was that all about?
The
patient had a rash and was quite unwell too – we don’t see that in the lab.
Eventually a diagnosis was made.
Drug
rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe reaction
to a drug after a prolonged latency period.
There
can be a variety of clinical symptoms including fever rash lymphadenopathy eosinophilia,
and a wide range of mild-to-severe systemic presentations.
That’s
rather vague isn’t it? But DRESS illustrates an interesting point. The
introduction of new drugs has often led to a wide range of systemic and
cutaneous reactions.
When
hydantoin was introduced in the 1940s, reports of lymphadenopathy soon
followed. The lymph node biopsies in these cases demonstrated a lymphomatous
appearance, which was termed drug-induced pseudolymphoma.
Another
drug, carbamazepine, was found to induce a reaction consisting of a rash,
fever, and lymphadenopathy.
Such
a reaction was termed anticonvulsant hypersensitivity syndrome.
Shortly
thereafter, multiple drugs with a similar range of manifestations were
observed. Hence the term drug-induced hypersensitivity also known as
hypersensitivity syndrome was coined.
The
term DRESS was eventually introduced, and looks to be possibly superceded by
the term drug-induced delayed multiorgan hypersensitivity syndrome.
All
of these different terms describe what is effectively the same condition…
Here’s
some articles on DRESS:
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