AB1156 Dress (DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS): looks may be deceptive!. (12th June 2018) - Mistry, R.
Abstract : Background: Drug reaction with eosinophilia and systemic symptoms(DRESS) is a rare, potentially life threatening multisystem disorder with fever, skin eruptions, lymphadenopathy, eosinophilia and systemic involvement most commonly after a drug exposure. These cases may mimic various rheumatological conditions. We report a series of 14 cases of DRESS who presented to Rheumatology Clinic as suspected connective tissue disease or sepsis in Northern India. Objectives: To highlight DRESS as a common mimic of common rheumatologic conditions and sepsis and report its etiology, characteristics, treatment and prognosis Methods: We manually searched the inpatient records of Immunology Department in SGPGI 2007–18 for the cases discharged with a diagnosis of possible/probable/definite DRESS. The records of the patients with probable and definite DRESS according to regiSCAR critera 1 were reviewed. Results: All the 14 patients fulfilled clinical criteria for diagnosis (4 probable, 10 definite). The age of patients ranged from 9–53 years with majority in their 3rd decade. Majority of the patients were referred to us when their counts were rising in the setting of fever and skin rashes with a suspicion of rheumatic disease/sepsis. The clinical and laboratory features of these patients are as follows (table 1): TLC: Total Leucocyte Count, AEC: Absolute Eosinophil Count, ED: Exfoliative dermatitis, F: facial oedema, M: maculopapular rash, L: Liver, K: Kidney, P: Lung, G: GI, SSZ: Sulphasalazine, HRZE: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, FU: Follow up All the patients were treated with oral steroids showing signs of clinical improvement within 4–5 days. Rashes and leucocyte count were first to respond. Transaminitis responded within a week. Mean Followup is 9.3 months. They were gradually tapered off steroids over next 3–4 months except for two patient who were lost to follow up. Conclusions: – Skin rash, arthritis, multi-organ failure of DRESS closely mimic rheumatologic disorders or sepsis (especially with rising TLC) - As early diagnosis is imperative for successful outcome, low threshold of suspicion is necessary. Reference: [1] Kardaun SH, Sidoroff A, Valeyrie-Allanore L, et al. Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: Does a DRESS syndrome really exist?Br J Dermatol2007; 156:609. Disclosure of Interest: None declared