Dapsone-induced DRESS after infliximab-induced vasculitis: a case of cerebral infarction in the context of multiple drug reactions. Issue 12 (17th December 2020)

• Record Type: Journal Article
• Authors: Roth, Michael; Gray, Jeffery T; Peterson, Paul Gabriel; Clark, Paul A
• Is Part Of: BMJ case reports. Volume 13:Issue 12(2020)
• Publication Date: 2020-12-17
• Subjects: vasculitis -- dermatology -- contraindications and precautions -- neurology -- adult intensive care; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-237560
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening condition characterised by peripheral eosinophilia, rash and multi-organ failure arising several weeks after exposure to the culprit medication. Although rare, DRESS syndrome triggered by specific agents has been associated with specific genetic polymorphisms more prevalent in different ethnic groups, including an association between dapsone-induced DRESS and Human Leukocyte Antigen (HLA)-B:13*01, a single nucleotide polymorphism more prevalent in those of Asian descent. DRESS and drug-related vasculitis may affect any organ system including the central nervous system (CNS), usually manifesting as encephalitis, meningitis or embolic cerebrovascular accidents related to eosinophilic cardiac disease and thrombosis. CNS vasculitis is a much rarer complication of drug reactions that may manifest as multifocal ischemia on neuroimaging. In circumstances of drug-related vasculitides, treatment with high-dose corticosteroids may lead to rapid improvement and, ultimately, resolution of associated focal neurologic deficits.