DreSS Syndrome

What is DRESS Syndrome?

DRESS Syndrome, which stands for Drug Reaction with Eosinophilia and Systemic Symptoms, is a severe drug reaction characterized by a rash that spreads and involves other systemic symptoms. It often occurs several weeks after the initiation of a new medication. The rash can appear in many different ways, most commonly it resembles a normal drug rash (morbilliform rash), but oftentimes patients are sicker and may have swelling around their face or ears in association with it.

This condition is accompanied by a high number of eosinophils, a type of white blood cell, in the blood. It can also affect various organs including the liver, kidneys, and lungs. The syndrome has a mortality rate of about 10%, thus immediate medical attention is vital.

What causes DRESS Syndrome?

DRESS Syndrome is mainly caused by an adverse reaction to certain medications. Some of the drugs most commonly associated with this syndrome include:

• Anticonvulsants (like phenytoin, carbamazepine)

• Allopurinol

• Sulfonamides

• Antipsychotics

• Antibiotics (like minocycline)

• Antiretroviral drugs

The exact reason why some individuals develop DRESS Syndrome is not fully understood, but it seems to involve a complex interaction between drug metabolism, viral reactivation, and the immune system.

What are the symptoms of DRESS Syndrome?

The symptoms of DRESS Syndrome generally develop two to six weeks after the initiation of the causative drug. The symptoms might include:

• Fever

• Rash that spreads and becomes severe

• Lymph node enlargement

• Elevated levels of eosinophils in the blood

• Involvement of internal organs such as the liver, kidneys, and sometimes the lungs, leading to various symptoms like jaundice, abnormal liver function tests, and kidney failure

Patients experiencing these symptoms should seek medical attention immediately.

How do I treat DRESS Syndrome?

The primary step in treating DRESS Syndrome is the discontinuation of the suspected causative drug. Treatment primarily involves managing the symptoms and might include:

• Hospitalization, often in a specialized unit depending on the organ involvement

• Systemic corticosteroids to control inflammation

• Supportive care for affected organs, which might include dialysis for kidney failure or specific interventions for other organ failures

• Monitoring and managing complications, including infections that can occur due to the impaired immune response

It is crucial for individuals to work closely with their healthcare provider to determine the best course of treatment.