Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Definition:
• Severe adverse drug reaction, characterized by extensive skin rash in association with visceral organ involvement, lymphadenopathy, eosinophilia and atypical lymphocytosis.
Symptoms:
• The latency phase typically ranges from 2-8 weeks.
• Maculopapular eruption that may progress to a coalescing erythema, in a symmetrical distribution on trunk and extremities.
• Facial Edema in 70% of cases.
Criteria for Diagnosis:
1. Fever >38.5
2. Enlarged LN in at least 2 different areas
3. Eosinophilia
4. Atypical Lymphocytes
5. Skin involvement
6. Organ involvement
7. Resolution > 15 days
Differentials:
• Exanthematous drug reaction
• SJS/TEN
• Acute Generalized Exanthematous Pustulosis
Management:
Drug withdrawal
• Mild disease: symptomatic treatment
• Severe disease:
1. Oral/IV Glucocorticoids
2. Second Line Therapy: Cyclosporin, IVIg and Tofacitinib [JAK Inhibitor]
Sinai Hospital of Baltimore IM Residency @SinaiBmoreIMRes
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