Sindrome De Dress

REVIEW

The DRESS Syndrome: A Literature Review
Patrice Cacoub, MD, PhD,a,b Philippe Musette, MD, PhD,c Vincent Descamps, MD, PhD,e,f Olivier Meyer, MD, PhD,g Chris Speirs, MD,h Laetitia Finzi, MD, PhD,i Jean Claude Roujeau, MDd
Department of Internal Medicine, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, Paris France; bPierre and Marie Curie University, Paris, France;cDepartment of Dermatology, Rouen University Hospital and INSERM Unit 905, Rouen, France; d Department of Dermatology, Henri-Mondor Hospital, Assistance Publique–Hôpitaux de Paris, France; eUniversité Paris-Est Créteil Val de Marne, France; fDepartment of Dermatology and gDepartment of Rheumatology, Bichat-Claude Bernard Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France; hEpsom and StHelies University Hospitals NHS Trust, Surrey, UK; iDepartment of Medical Writing, ClinSearch, Bagneux, France.
a

ABSTRACT The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. We used the RegiSCAR scoring system that grades DRESS cases as “no,”“possible,” “probable,” or “definite” to classify cases reported in the literature. We also analyzed the clinical course and treatments of the cases. A total of 44 drugs were associated with the 172 cases reported between January 1997 and May 2009 in PubMed and MEDLINE. The most frequently reported drug was carbamazepine, and the vast majority of cases were classified as “probable/definite” DRESScases. Hypereosinophilia, liver involvement, fever, and lymphadenopathy were significantly associated with “probable/definite” DRESS cases, whereas skin rash was described in almost all of the cases, including “possible cases.” Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. The outcome was death in 9 cases. However, no predictive factors for serious cases werefound. This better knowledge of DRESS may contribute to improve the diagnosis and management of this syndrome in clinical practice. © 2011 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2011) 124, 588-597 KEYWORDS: Drug hypersensitivity; Drug rash; Eosinophilia; HHV-6; Systemic symptoms

The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adversedrug-induced reaction. The estimated incidence of this syndrome ranges from 1 in
Funding: This work was funded by Institut de Recherche Internationale Servier. Conflict of Interest: Pr. Jean Claude Roujeau has provided punctual advice on cases of adverse reactions to drugs from more than 15 different pharmaceutical companies in the past 20 years. He has served as an expert on 3 trials related tosevere drug reactions in US Courts. He is a member of advisory boards on Severe Cutaneous Adverse Reactions for Pfizer (2002-2007), Vertex (2008-ongoing), Servier (2008-ongoing), Boehringer Ingelheim (2010-ongoing), Roche (2010-ongoing). He has participated in the RegiSCAR research group, funded in part by several pharmaceutical companies (detailed list provided in publications by the RegiSCAR group,eg, Sassolas B et al. Clin Pharmacol Ther. 2010;88[1]:60-8). No other authors have any conflicts of interest to report. Authorship: All authors had access to the data and played a role in writing this manuscript. Requests for reprints should be addressed to Patrice Cacoub, MD, PhD, Department of Internal Medicine, Pitié-Salpêtrière Hospital, 47-83 boulevard de l’Hôpital, F-75651 Paris cedex 13,France. E-mail address: patrice.cacoub@psl.aphp.fr

1000 to 1 in 10,000 drug exposures.1 The acronym designated by Bocquet et al2 describes a potentially life-threatening syndrome including a severe skin eruption, fever, hematologic abnormalities (eosinophilia or atypical lymphocytes), and internal organ involvement. The other noteworthy features are a delayed onset, usually 2-6 weeks after the...