Thursday, July 22, 2010

Addressing DRESS


This is from the UCSD Medical Images site.









DRESS Syndrome - Drug Reaction with Eosinophilia and Systemic Symptoms. Also known as drug hypersensitivity reactions.
These commonly present 2 or more weeks after initiating a new medication, and is manifested by:
  • Fever
  • Rash: papular, macular, bullous
  • Lymphadenopathy
  • Arthralgias
  • Hepatitis
  • Eosinophilia (in many cases)
Medications commonly associated with DRESS syndrome include "aromatic" anticonvulsants (phenytoin, carbamazepine, and phenobarbitol) - but can occur with other anticonvulsants as well. Other classic drugs include NSAIDS, abacavir, and allopurinol. Treatment revolves around stopping the culpret agent, supportive care, and perhaps steroid therapy in severe cases.


In the case of abacavir, a drug used in HIV treatment, hypersensitivity reactions are known to occur in those who are HLA B5701-positive. Screening programs are now widely used to prevent this reaction. Here is the sentinel article from NEJM. You will be hearing a lot more about "personalized medicine" in the near future.

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