Drug Reaction With Eosinophilia and Systemic Symptoms

OBJECTIVE: To investigate the clinical and pathologic features of patients with drug reaction with eosinophilia and systemic symptoms (DRESS) in Taiwan. DESIGN: Case series and retrospective analysis. SETTING: A medical referral center in Northern Taiwan. PATIENTS: Sixty cases of DRESS occurring from June 1998 to May 2008. MAIN OUTCOME MEASURES: Clinical characteristics for specific drugs and important prognostic factors in DRESS. RESULTS: Patients ranged in age from 6 to 90 years (mean age, 51 years). The female to male ratio was 1.3 to 1. The most common culprit drugs were allopurinol, phenytoin, and dapsone. Exanthematous eruption was the most common skin manifestation, but purpurae and blisters were also observed. Hepatic (80%), renal (40%), and pulmonary (33%) involvement were also common. The overall mortality rate was 10%. Allopurinol-induced DRESS was characterized by preceding chronic renal insufficiency and frequent renal involvement. Pancytopenia indicated a poor prognosis. CONCLUSIONS: Drug reaction with eosinophilia and systemic symptoms has a variable clinical presentation, and its definition requires clarification. It may be a heterogeneous syndrome with some particular patterns related to different drugs. Early diagnosis and prompt discontinuation of offending drug regimens are essential.