Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 May;6(3):216-21.
doi: 10.4168/aair.2014.6.3.216. Epub 2014 Feb 6.

Comparison of diagnostic criteria and determination of prognostic factors for drug reaction with eosinophilia and systemic symptoms syndrome

Dong-Hyun Kim  1 , Young-Il Koh  1
Affiliations

Comparison of diagnostic criteria and determination of prognostic factors for drug reaction with eosinophilia and systemic symptoms syndrome

Dong-Hyun Kim et al. Allergy Asthma Immunol Res. 2014 May.

Abstract

Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by prolonged clinical symptoms even after the withdrawal of the culprit drug. Different criteria to diagnose DRESS syndrome have been proposed; however, there have been limited studies on prognostic factors. We investigated appropriate criteria for the diagnosis of DRESS syndrome in practice and with associated prognostic factors.

Methods: A total of 48 patients with DRESS syndrome that satisfied RegiSCAR possible (or more) criteria were retrospectively recruited. They were also analyzed according to Bocquet's criteria and Japanese drug-induced hypersensitivity syndrome (DIHS) criteria. The duration of clinical manifestations, requirement for steroids, and fatalities determined the severity of DRESS syndrome. Blood tests were performed at initial presentation to our hospital.

Results: A total of 60.4% of patients satisfied RegiSCAR definite criteria and 77.1% satisfied Bocquet's criteria. Only 18.8% satisfied atypical DIHS criteria from the Japanese group. A total of 96.6% patients who fit the RegiSCAR definite criteria, 96.6% also satisfied Bocquet's criteria; reciprocally, 75.7% of patients who met Bocquet's criteria also satisfied RegiSCAR definite criteria. The duration of clinical symptoms positively correlated with leukocyte, lymphocyte, and eosinophil counts in non-fatal cases. Lymphocyte counts were higher in patients who used steroids compared to steroid-naïve patients. Fatal cases showed higher serum creatinine and ferritin levels compared to non-fatal cases.

Conclusions: Bocquet's criteria is efficient and appropriate to diagnose DRESS syndrome in clinical practice. Lymphocyte and eosinophil counts as well as creatinine and ferritin levels could be useful early prognostic factors.

Keywords: Diagnosis; drug hypersensitivity; lymphocytes; prognosis.

PubMed Disclaimer

Conflict of interest statement

There are no financial or other issues that might lead to conflict of interest.

Figures

Fig. 1
Fig. 1
Proportion of patients who satisfied different criteria for DRESS syndrome. RegiSCAR possible means the group of patients that satisfied possible RegiSCAR (or more) criteria in the scoring system; RegiSCAR probable means the group of patients that satisfied probable or more criteria; RegiSCAR definite means the group of patients that satisfied definite criteria; Bocquet means the group of patients that satisfied Bocquet's criteria; Atypical DIHS means the group of patients that satisfied atypical DIHS criteria.
Fig. 2
Fig. 2
Correlations between blood (WBCs) (A), lymphocytes (B), or eosinophils (C) and the duration of clinical symptoms in 34 non-fatal patients with DRESS syndrome.
Fig. 3
Fig. 3
Comparison of blood lymphocyte counts between steroid-naïve and steroid-used patients with DRESS syndrome.
Fig. 4
Fig. 4
Comparisons of serum creatinine (A) and ferritin (B) levels between non-fatal and fatal patients with DRESS syndrome.
See this image and copyright information in PMC

References

    1. Wolf R, Orion E, Marcos B, Matz H. Life-threatening acute adverse cutaneous drug reactions. Clin Dermatol. 2005;23:171–181. - PubMed
    1. Tas S, Simonart T. Management of drug rash with eosinophilia and systemic symptoms (DRESS syndrome): an update. Dermatology. 2003;206:353–356. - PubMed
    1. Cacoub P, Musette P, Descamps V, Meyer O, Speirs C, Finzi L, Roujeau JC. The DRESS syndrome: a literature review. Am J Med. 2011;124:588–597. - PubMed
    1. Bocquet H, Bagot M, Roujeau JC. Drug-induced pseudolymphoma and drug hypersensitivity syndrome (drug rash with eosinophilia and systemic symptoms: DRESS) Semin Cutan Med Surg. 1996;15:250–257. - PubMed
    1. Shiohara T, Inaoka M, Kano Y. Drug-induced hypersensitivity syndrome (DIHS): a reaction induced by a complex interplay among herpesviruses and antiviral and antidrug immune responses. Allergol Int. 2006;55:1–8. - PubMed