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
Review
. 2019 Nov;36(6):887-892.
doi: 10.1111/pde.13949. Epub 2019 Aug 18.

Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Kate E Oberlin  1 , Sahand Rahnama-Moghadam  1 , Ahmed K Alomari  1   2 , Anita N Haggstrom  1
Affiliations
Review

Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Kate E Oberlin et al. Pediatr Dermatol. 2019 Nov.

Abstract

Background: Pediatric Drug reaction with eosinophilia and systemic symptoms (DRESS) is an uncommon disease that can be difficult to diagnose. This case series and literature review highlights the clinical features of pediatric DRESS and underscores the differential diagnoses, culprit medications, and need for clinical follow-up to detect associated autoimmune sequelae.

Objective: To describe the clinical and laboratory features of pediatric DRESS, identify associated culprit medications, and discuss the natural history of disease.

Methods: Ten cases of pediatric DRESS were identified in the electronic medical record by searching the inpatient dermatology consultation list at Indiana University between 2013 and 2018. Clinical and laboratory data were collected including demographics, differential diagnoses, culprit medications, resolution of disease, and autoimmune sequelae.

Results: Pediatric patients with DRESS presented at a mean age of 11.5 years and demonstrated a mean time from drug initiation to onset of symptoms of 4 weeks. The most common inciting drugs included antibiotics (62.5%) followed by antiepileptics (37.5%). Rash and transaminitis resolved by 3 weeks, and 20% of patients, all female, developed autoimmune sequelae including Hashimoto's thyroiditis and an undifferentiated connective tissue disorder and occurred at an average of 14.5 weeks after diagnosis.

Limitations: This was a small retrospective study of an uncommon clinical diagnosis at a single institution.

Conclusions: Pediatric DRESS was most commonly caused by antibiotics which are being increasingly recognized in the literature as the predominant culprit medications. The development of autoimmune sequelae is a notable consequence that can present weeks after illness and may preferentially affect female patients.

Keywords: autoimmune sequelae; drug reaction with eosinophilia and systemic symptoms; drug-induced hypersensitivity; pediatric dermatology.

PubMed Disclaimer

References

REFERENCES

    1. Besli GE, Yildirim S, Yilmaz K, Yuksel E. DRESS syndrome or hematologic malignancy? A case report of a 4-year-old boy. Pediatr Emerg Care. 2017;33(7):494-496.
    1. Chow ML, Kim D, Kamath S, Peng D, Luu M. Use of antiviral medications in drug reaction with eosinophilia and systemic symptoms (DRESS): A case of infantile DRESS. Pediatr Dermatol. 2018;35(2):e114-e116.
    1. Terlemez S, Demir F, Bulut Y, et al. DRESS syndrome developed related to acetylsalicylic acid use. Pediatr Allergy Immunol. 2016;27(2):227-230.
    1. Lee JY, Lee SY, Hahm JE, Ha JW, Kim CW, Kim SS. Clinical features of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: A study of 25 patients in Korea. Int J Dermatol. 2017;56(9):944-951.
    1. Kardaun SH, Sekula P, Valeyrie-Allanore L, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): An original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013;169(5):1071-1080.

Substances

LinkOut - more resources