Drug rash with eosinophilia and systemic symptoms
Drug rash with eosinophilia and systemic symptoms (DRESS) is a syndrome reflects a marked hypersensitivity reaction to drugs / medications. It is characterised by skin rash, fever, lymph node enlargement, and internal organ involvement. In terms of internal organ involvement, it most commonly involves the liver followed by the kidneys and lungs.
Clinical presenatation can be variable and precipitations of symptoms can range from 2 to 8 weeks after initiating the offending drug.
The pathophysiology of DRESS syndrome is not well known. Many drug have been be known to cause precipitation of this syndrome and includes
- gold salt
- serum eosinophils are often elevated 5
Non specific but may be represented by diffuse multifocal infiltrative opacification 5.
Treatment and prognosis
The prognosis can be variable but can carry a mortality of up to around 10% in patients with multi-organ involvement. Withdrawal of the causative drug and steroid therapy as traditionally been a mainstay of treatment.
History and etymology
It was first described in 1996 by Bocquet et al 1.
- 1. Lee JH, Park HK, Heo J et-al. Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome induced by celecoxib and anti-tuberculosis drugs. J. Korean Med. Sci. 2008;23 (3): 521-5. doi:10.3346/jkms.2008.23.3.521 - Free text at pubmed - Pubmed citation
- 2. Tsyrulnik A, Landman A. Drug rash with eosinophilia and systemic symptoms: two emergency department cases. West J Emerg Med. 2011;12 (4): 559-62. doi:10.5811/westjem.2010.11.2077 - Free text at pubmed - Pubmed citation
- 3. Fleming P, Marik PE. The DRESS syndrome: the great clinical mimicker. Pharmacotherapy. 2011;31 (3): 332. doi:10.1592/phco.31.3.332 - Pubmed citation
- 4. Cacoub P, Musette P, Descamps V et-al. The DRESS syndrome: a literature review. Am. J. Med. 2011;124 (7): 588-97. doi:10.1016/j.amjmed.2011.01.017 - Pubmed citation
- 5. Jeong YJ, Kim KI, Seo IJ et-al. Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Radiographics. 2007;27 (3): 617-37. doi:10.1148/rg.273065051 - Pubmed citation