The DRESS syndrome: a literature review

Am J Med. 2011 Jul;124(7):588-97. doi: 10.1016/j.amjmed.2011.01.017. Epub 2011 May 17.

Abstract

The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. We used the RegiSCAR scoring system that grades DRESS cases as "no," "possible," "probable," or "definite" to classify cases reported in the literature. We also analyzed the clinical course and treatments of the cases. A total of 44 drugs were associated with the 172 cases reported between January 1997 and May 2009 in PubMed and MEDLINE. The most frequently reported drug was carbamazepine, and the vast majority of cases were classified as "probable/definite" DRESS cases. Hypereosinophilia, liver involvement, fever, and lymphadenopathy were significantly associated with "probable/definite" DRESS cases, whereas skin rash was described in almost all of the cases, including "possible cases." Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. The outcome was death in 9 cases. However, no predictive factors for serious cases were found. This better knowledge of DRESS may contribute to improve the diagnosis and management of this syndrome in clinical practice.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Allopurinol / adverse effects
  • Carbamazepine / adverse effects
  • Diagnosis, Differential
  • Drug Eruptions / diagnosis*
  • Drug Eruptions / etiology
  • Drug Eruptions / mortality
  • Eosinophilia / chemically induced*
  • Eosinophilia / diagnosis*
  • Eosinophilia / mortality
  • Exanthema Subitum / diagnosis
  • Exanthema Subitum / virology
  • Female
  • Fever / chemically induced*
  • Herpesvirus 6, Human / isolation & purification
  • Humans
  • Lymphatic Diseases / chemically induced*
  • Male
  • Middle Aged
  • Syndrome
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Carbamazepine
  • Allopurinol