Morning Report

Morning Report: 2/10/2015

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Here’s Dr. Bart with today’s Morning Report!

 

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

 

PRESENTATION:

  • ­Typical onset 2­6 weeks (within 2 months)
  • ­Most common inciting drugs:
    • Aromatic Anticonvulsants: Phenytoin, phenobarbital, allopurinol, sulfa
    • NSAIDS, antiretroviral medications, ACE inhibitors, calcium channel blockers, antibiotics
  • ­Fever and rash then systemic symptoms which may present as malaise
  • Eosinophilia (30%)
  • Hepatic and renal dysfunction
  • High mortality rate ­ 8­10%

 

APPEARANCE:

  • ­Variable, symmetric generally on trunk and extremities
  • Erythematous and scaly to blistering (exfoliative erythroderma to SJS)
  • Morbilliform eruption similar to exanthematous drug eruption which may progress to exfolitiative dermatitis/erythroderma → purpura and sterile pustules.
  • Scaling and/or desquamation possible with healing
  • Facial edema

 

TREATMENT:

  • ­STOP inciting medication
  • Steroids
  • Supportive care: antipyretics and antipruritics
  • Admission
  • Genetics counseling ­ may be genetic disposition in ability to metabolize certain drugs

 

References:

  1. Thomas J, Perron AD, Brady WJ. Chapter 245. Serious Generalized Skin Disorders. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka

    RK, Meckler GD, T. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw­Hill; 2011.

    http://accessmedicine.mhmedical.com.newproxy.downstate.edu/content.aspx?bookid=348&Sectionid=40381732

  2. Velez NF, Saavedra AP. Chapter 142. Adverse Cutaneous Drug Reactions. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Principles and Practice of Hospital Medicine. New York, NY: McGraw­Hill; 2012. http://accessmedicine.mhmedical.com.newproxy.downstate.edu/content.aspx?bookid=496&Sectionid=41304123.
  3. Wolff K, Johnson R, Saavedra AP. Section 23. Adverse Cutaneous Drug Reactions1. In: Wolff K, Johnson R, Saavedra AP. eds. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 7e. New York, NY: McGraw­Hill; 2013. http://accessmedicine.mhmedical.com.newproxy.downstate.edu/content.aspx?bookid=682&Sectionid=45130155.
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital
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