Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part II diagnosis and management.

Drug-induced hypersensitivity syndrome, also known as drug reaction with eosinophilia and systemic symptoms, is a severe cutaneous adverse reaction characterized by an exanthem, fever, and hematologic and visceral organ involvement. The differential diagnosis includes other cutaneous adverse reactions, infections, inflammatory and autoimmune diseases, and neoplastic disorders. Three sets of diagnostic criteria have been proposed; however, consensus is lacking. The cornerstone of management is immediate discontinuation of the suspected drug culprit. Systemic corticosteroids remain first-line therapy, but the literature on steroid-sparing agents is expanding. Longitudinal evaluation for sequelae is recommended. Adjunctive tests for risk stratification and drug culprit identification remain under investigation. Part II of this continuing medical education activity begins by exploring the differential diagnosis and diagnosis of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms and concludes with an evidence-based overview of evaluation and treatment.

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part I. Epidemiology, pathogenesis, clinicopathological features, and prognosis.

Drug-induced hypersensitivity syndrome (DiHS), also known as drug reaction with eosinophilia and systemic symptoms (DRESS), is a severe cutaneous adverse reaction (SCAR) characterized by an exanthem, fever, and hematologic and visceral organ involvement. Anticonvulsants, antibiotics, and allopurinol are the most common triggers. The pathogenesis involves a complex interplay between drugs, viruses, and the immune system primarily mediated by T-cells. DiHS/DRESS typically presents with a morbilliform eruption 2-6 weeks after drug exposure, and is associated with significant morbidity, mortality, and risk of relapse. Long-term sequelae primarily relate to organ dysfunction and autoimmune diseases. Part I of this continuing medical education activity on DiHS/DRESS provides an update on epidemiology, novel insights into pathogenesis, and a description of clinicopathological features and prognosis.

Exanthematous Drug Eruption to Intravenous Iron: A Case Report.

The authors present a rare case of an exanthematous drug reaction to intravenous iron. Exanthematous drug eruptions, also called morbilliform or maculopapular drug rashes, can occur in first-time drug exposures and represent a subtype of delayed-type IV hypersensitivity reactions.  This patient is a 49-year-old female with a history of iron deficiency anemia and hypothyroidism who presented to the emergency department after experiencing a diffuse whole-body maculopapular rash following ferumoxytol 510 mg intravenously received once two days prior to her presentation. A clinical examination was suspicious of an exanthematous drug eruption. The patient was treated with methylprednisolone 40 mg intravenously twice a day for three days, followed by prednisone 40 mg orally twice a day for two days with a steroid taper upon discharge. The patient's rash resolved within five days of steroid treatment. There is a high global prevalence of iron deficiency anemia for which intravenous iron replacement may be required. However, there is limited research addressing its adverse effects, particularly those that include delayed hypersensitivity reactions. This paper aims to alert healthcare professionals of a rare type of delayed hypersensitivity reaction to intravenous iron to better guide management in the clinical setting.

Time After Time: A Second Look at Evolving Rash With Multiple Exposures to Amoxicillin.

Pediatric penicillin drug reactions may present in many forms such as erythema multiforme, serum-sickness, serum-sickness-like reaction (SSLR), Henoch-Schonlein Purpura (HSP), and urticarial vasculitis. Here, we review the case of a 13-month-old with atypical presentation of a drug reaction with increasing severity after each exposure to amoxicillin. We discuss the various differential diagnoses in comparison to our patient's presentation and conclude with the recommendation of considering timing and previous exposures in the diagnosis of drug-associated rashes in pediatric population.

Diffuse exanthematous drug eruption associated with intravenous immunoglobulin.

Diffuse exanthematous drug eruption due to intravenous immunoglobulin (IVIg) is a rare adverse event reported only in case reports. We present a case of a 71-year-old woman with a diffuse maculopapular rash 5 days after receiving an IVIg infusion for treatment of chronic inflammatory demyelinating polyneuropathy. She was managed conservatively with antihistamines; she was already receiving prednisone 25 mg daily as part of treatment for the neuropathy. The rash resolved over 2 weeks.

A Study of Cutaneous Adverse Drug Reactions in a Tertiary Care Center in Punjab.

CONTEXT: Cutaneous adverse drug eruptions are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated. AIMS: To study the pattern of various types of cutaneous adverse drug reactions (CADRs), to find out the causative drug(s) involved and to determine the response to treatment and outcome in patients with CADRs. PATIENTS AND METHODS: This prospective study was done in the department of dermatology. Patients with suspected drug rash, of either sex and all age groups were included in the study. STATISTICAL ANALYSIS: Frequencies and proportions were calculated using Chi-square test and t-test as the tests of significance. Data was analyzed using SPSS version 21. RESULTS: A total of 258 patients were enrolled in the study. The most common CADR observed in the study was exanthematous drug eruption in 42.63% patients followed by drug induced urticaria in 21.32% patients. Antimicrobials were the most common offending drugs in 64.73% of patients, followed by non-steroidal anti-inflammatory drugs (NSAIDs) in 15.50% patients. In the study, 12 patients (4.65%) were found to have severe cutaneous adverse drug reactions (SCADRs). Stevens-Johnson syndrome (SJS) - Toxic epidermal necrolysis (TEN) was the most common SCADR (50%) and antituberculous drugs were the most common causative group of drugs causing SCADRs. CONCLUSION: The most common CADR observed in the study was exanthematous drug eruption and antimicrobials were the most common causative drugs.