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Skin symptoms of DRESS syndrome vary and include the following: disuse infiltrative maculopapules, exfoliation, facial edema and urticaria. (A) Diffuse erythematous papules and plaques on the right forearm and dorsum of hand (patient #8). (B) Diffuse scaly eczematous lesions on the face (patient #13). DRESS, drug reactions with eosinophilia and systemic symptoms.
Source publication
Purpose
Although there have been reported cases of drug reactions with eosinophilia and systemic symptoms (DRESS) syndrome caused by antituberculosis drugs, there has been no research to examine its prevalence. This study assessed the prevalence and clinical characteristics of DRESS syndrome caused by antituberculosis drugs.
Methods
The electronic...
Contexts in source publication
Context 1
... and preceded eosinophilia in the peripheral blood. The median time from the onset of skin presentations to the observation of eosinophilia was 4 days (IQR 2-9). Among the skin manifestations, diffuse infiltrative maculopapules was the most common finding observed in all patients; this was followed by exfoliation, which was observed in 4 patients (Fig. 2); facial edema, which was observed in three patients; and urticaria, which was observed in one patient. The median peak eosinophil count was 2,270 (IQR 1,680-4,920)/μL. As for systemic symptoms, fever was observed in 14 patients (93.3%), hepatic involvement was observed in 5 patients (33.3%), and renal involvement was observed in 4 ...
Similar publications
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after the use of first-line antitubercular drugs (ATDs) is rare and literature regarding DRESS syndrome due to ATDs is scarce in children. We report a young boy with tuberculosis who developed DRESS syndrome after exposure to isoniazid. A 9-year-old boy, diagnosed clinically as...
Background
Anti-tuberculosis drugs (ATD) induced DRESS syndrome is rarely reported, and its diagnosis and management are very challenging.
Case presentation
A 33-year-old woman presented with fever, maculopapular rashes, hypereosinophilia, and hepatic involvement, which occurred 4 weeks after a fixed-dose combination of first-line ATD containing r...
Citations
... All anti-TB drugs pose a risk of DRESS; Rifampicin and isoniazid are the most frequently reported drugs. [24][25][26] DRESS is characterized by skin rash (morbilliform), fever, eosinophilia, lymphadenopathy, and systemic symptoms (hepatitis, interstitial pneumonia, and myocarditis). The mortality rate is 5%-10%, mainly due to fulminant hepatitis. ...
Background
Chronic kidney disease (CKD) patients are at a high risk of tuberculosis (TB), with a relative risk of developing active TB of 10%–25%. Similarly, glomerular disease increases the risk of TB due to diminished glomerular filtration rate, proteinuria, and immunosuppression use. Further, the first-line anti-TB drugs are associated with acute kidney injury (AKI) even in patients with normal kidney functions.
Methods
We retrospectively identified 10 patients hospitalized with unusual adverse effects of antituberculosis therapy (ATT) from 2013 to 2022.
Results
We found three cases of AKI caused by rifampicin: acute interstitial nephritis, crescentic glomerulonephritis, and heme pigment-induced acute tubular necrosis. We observed rifampicin-induced accelerated hypertension and thrombocytopenia in two patients on maintenance hemodialysis. Isoniazid caused pancreatitis and cerebellitis in two CKD patients, respectively. In a CKD patient, we detected acute gout secondary to pyrazinamide-induced reduced uric acid excretion. We also observed cases of drug rash with eosinophilia and systemic symptoms and hypercalcemia due to immune reconstitution inflammatory syndrome in patients with glomerular disease on ATT. Immediate discontinuation of the offending drug, along with specific and supportive management, led to a recovery in all cases.
Conclusion
The adverse effects of ATT may be unusually severe and varied in kidney patients due to decreased renal elimination. Early recognition of these adverse effects and timely discontinuation of the offending drug is essential to limit morbidity and mortality.
... 5,6 First-or second-line anti-tubercular (anti-TB) drugs have also been found to be associated with this clinical entity of DRESS syndrome. 2,[7][8][9] Approximately 60% of TB patients experience some kind of adverse drug reaction during therapy. Adverse drug reactions caused by anti-TB drugs are the leading cause of treatment failure, and reduced drug compliance and thus may cause an increase in mortality and morbidity. ...
... However, if the responsible drugs are identified accurately, TB could be managed effectively with alternative and safe anti-TB drugs. [8][9][10] Different studies reported that most of the patients with this syndrome recover completely in weeks to months after the withdrawal of the responsible drug. 2,8 The pathological mechanism behind DRESS syndrome is not well known. ...
... [8][9][10] Different studies reported that most of the patients with this syndrome recover completely in weeks to months after the withdrawal of the responsible drug. 2,8 The pathological mechanism behind DRESS syndrome is not well known. The four first-line anti-TB drugs viz rifampicin, isoniazid, pyrazinamide, and ethambutol are administered concomitantly in the treatment of TB. ...
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, while uncommon, presents a potentially hazardous condition. It is a drug-induced multi‑system immunological hypersensitivity reaction, characterized by the triad of fever, rash, and internal organ involvement. This is a case report of a 60-year-old Indian female who developed a repeat episode of DRESS syndrome following modified anti-tuberculosis therapy (ATT). She had a past history of DRESS syndrome caused by first-line antitubercular drugs. This case report aims to highlight the challenges in managing DRESS syndrome in the context of tuberculosis (TB) treatment, as well as to emphasize the importance of prompt withdrawal of the culprit drugs and immediate initiation of appropriate supportive care. This case report also highlights the high risk of recurrence of DRESS syndrome following the re-administration of the offending medication, especially antitubercular drugs.
... %) were cases of carbapeneminduced DRESS, 46 (18.1%) were cases of vancomycin-associated DRESS. 19 In 2019, 15 of 1253 adult patients with tuberculosis receiving antituberculosis drugs were identified as potential cases of DRESS syndrome, and the prevalence of DRESS was 1.2 %. 20 The prevalence of DRESS in pediatric patients with bone and joint infections and DRESS in pediatric patients with other types of infections is still unknown, and there is no data in the literature. To date, only 3 cases of cefotaximeinduced and a few cases of vancomycin-induced DRESS syndrome have been reported in the literature. ...
Background
Bone and joint infections are common in children, particularly those under 10 years of age. While antimicrobial therapy can often successfully treat these infections, surgical drainage may also be necessary. It is important to note that prolonged courses of treatment have been associated with adverse events and drug reactions. Among these, drug reactions with eosinophilia and systemic symptoms (DRESS) syndrome is particularly severe and potentially life-threatening. We aimed to evaluate the cases of DRESS syndrome that develop during the treatment of bone and joint infections.
Methods
A retrospective study was conducted at a tertiary-level university hospital between 2015 and 2022 to determine the incidence and outcomes of definite DRESS Syndrome in children under 18 years of age with bone and joint infections.
Results
Of 73 patients with bone and joint infections, 16 (21.9 %) children developed antimicrobial therapy-induced DRESS syndrome. Eight (50 %) of these children were boys; the mean age of the patients was 9.76 ± 5.5 years. DRESS syndrome occurred in 16 children, including 13 children with osteomyelitis, 1 child with osteomyelitis and septic arthritis, and 2 children with septic arthritis and sacroiliitis. The mean duration of intravenous antibiotic therapy was 40.6 ± 16.6 days; the mean hospital stay was 48.7 ± 23.7 days; the mean time for the development of DRESS syndrome after starting antibiotics was 19.6 ± 7.68 days. New onset fever (68.8 %) and rash (43.8 %) were the most common symptoms of DRESS Syndrome. Cefotaxime and vancomycin were drugs responsible for DRESS syndrome in 8 (50 %) of 16. The causative antibiotics were switched to another class of antibiotic, most commonly preferred was ciprofloxacin (n:5; 31.3 %). For children with persistent symptoms, steroids were used in 5 (31.25) patients.
Conclusions
Clinicians should be aware of DRESS syndrome in children who develop fever and rash under long-term antibiotics and should check hematological and biochemical parameters to predict the severity of DRESS syndrome. In patients with persistent symptoms, steroids may be used to control the symptoms.
... It is worth noting that the clinical manifestations described here could possibly also be those of rifampicin hypersensitivity, although this has been largely reported among TB patients on rifampicin and not leprosy patients. 16,17 Recent studies in China reveal the prospects of HLA-B*13:01 screening in reducing the incidence of DHS. 5,18,19 Remarkably, in a prospective cohort study employing this genetic marker, 18 none of the patients who received dapsone after testing negative for HLA-B*13:01, developed DHS, in contrast to the historical 1% DHS rate observed in the same population without preceding HLA-B*13:01 testing. ...
Background
Dapsone is an antibiotic used in the management of leprosy. Following the worldwide adoption of the dapsone-containing multidrug therapy for treating leprosy, an upsurge in the reported frequency of dapsone hypersensitivity syndrome (DHS) has been observed. DHS is associated with a high fatality rate among patients from low-resourced settings and patients with syndrome-associated hepatitis.
Case Presentation
This is a case of a Ghanaian male who, while being treated for leprosy with the multidrug therapy, developed exfoliative dermatitis and signs of liver damage, 6 weeks after treatment initiation. He was managed for dapsone-related exfoliative dermatitis and infectious causes of liver damage were investigated. However, the patient’s condition rapidly deteriorated with a fatal outcome despite discontinuation of dapsone. DHS was only considered as a differential diagnosis postmortem.
Conclusion
This case highlights the importance of having a high index of suspicion for DHS in all patients on dapsone and the need for a thorough workup for all leprosy patients who present with exfoliative dermatitis and signs of liver involvement within the latency period of the syndrome, especially in low resource settings. Furthermore, it stresses the need for prompt and appropriate treatment as DHS can quickly become fatal in such settings.
... All antituberculosis drugs are suspected to pose a risk of DRESS [10] . The prevalence of potential ATT induced DRESS is 1.2% [11] . In a literature review on antibacterial antibiotic induced DRESS by Sharifzadeh et al. [12] , 107 out of 254 cases were due to antituberculosis s. ...
... A drug hypersensitivity reaction, a subset of adverse drug reaction, is defined as "objectively reproducible symptoms or signs initiated by exposure to a defined stimulus at a dose tolerated by normal persons" by the WHO [11] . A drug reaction with demonstrated immunological mechanisms, either antibody or cell mediated, is referred to as drug allergy [14] . ...
... It is a delayed hypersensitivity reaction and seen to have a long latency period (2-8 weeks) between drug exposure and disease onset [4] . Jung et al. [11] in their retrospective cohort study, the median latency after administration of ATT was 42 days. Our case presented with DRESS after 5 weeks of starting treatment consistent with the literature [4] . ...
Unlabelled:
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening condition precipitated by reaction of therapeutic drugs. The prevalence of potential antitubercular therapy (ATT)-induced DRESS is 1.2%.
Case presentation:
A 71-year-old female patient after 5 weeks of starting ATT complaints of fever, vomiting, dizziness, and generalized itchy maculopapular rash over the body. It was associated with marked eosinophilia (absolute eosinophil count 3094 cell/mm3, 36% in peripheral blood smear).
Discussion:
Fever, rash, lymphadenopathy, and internal organ involvement with marked eosinophilia constitute the major clinical manifestations of DRESS. RegiSCAR scoring system is usually used to diagnose DRESS. Identification of the culprit drug is based on the temporal correlation of symptoms with drug exposure and rechallenge test, patch test and lymphocytic transformation tests may be valuable adjunctive tools. Treatment includes withdrawal of offending agent and use of topical or systemic corticosteroids, antihistamines, cyclosporin or JAK inhibitor with clinical judgement.
Conclusion:
Clinicians from the tuberculosis burden region must be aware of DRESS associated with ATT and they must counsel the patient properly before prescription and manage them without delay if DRESS ensues.
... These results are in accordance with those of previous data [6,[14][15][16][17][18][19]. Conversely, according to Asian studies, antibiotics and non-steroidal anti-inflammatory drugs were found to be major causative drugs of DRESS [4,28,29]. Cutaneous lesions observed in all our patients were actually the most often reported sign in DRESS. Maculopapular exanthema was the most frequent clinical pattern of skin changes. ...
Background
To date, no study has identified a clear relationship between drug and a specific clinical presentation of DRESS.
Objectives
To investigate the particularities of DRESS and analyze the variation of DRESS pattern according to culprit drugs.
Methods
We analyzed cases of DRESS notified to the Department of Clinical Pharmacology at the University Hospital of Monastir over a 15-year period. The statistical study was performed using the comparative and multivariate analysis.
Results
DRESS was mostly induced by anticonvulsive agents (27%) followed by allopurinol (26.3%) and antibiotics (24%): For anticonvulsive agents, the occurrence of lymphadenopathy was higher, renal involvement was rare and mild, and positive skin tests were more frequent. The allopurinol group was associated with the patient’s older age and a lower incidence of lymphadenopathy and kidney injury. For antibiotics, eosinophilia rate was lower, time to recovery was shorter, and RegiSCAR score was low. The multivariate analysis showed a link of allopurinol with severe renal impairment, antibiotics with short latency period and low RegiSCAR score, and anticonvulsants with high propensity of positive skin test.
Conclusion
We report the largest African and south Mediterranean cohort of DRESS and evaluated the usefulness of skin tests in identifying the culprit drug. The prominent finding was that latency period and renal involvement may independently differ according to culprit drugs.
... Antituberculosis drugs can cause DRESS syndrome in 1.2% of patients receiving these medicines. In a 4-year retrospective study, Ethambutol was associated with the majority of the events in up to 53.5%, followed by Rifampicin with 26.7% and isoniazid with 6.7% (6) . On the other hand, ALF can occur in 35% of patients with DILI with an overall mortality of 9.7%. ...
Drug induced liver injury (DILI) can be can be triggered by many medications including antituberculosis drugs. We present the case of a 37-year-old woman with a smear- positive pulmonary tuberculosis who started treatment with first-line antituberculosis drugs and 4 weeks later presented jaundice, somnolence and a morbilliform generalized rash with progressive neurologic deterioration which had a fatal outcome. Antituberculosis drugs can cause DILI in 2 to 28% of patients and drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) in 1.2%. Acute liver failure (ALF) can occur in 35% of patients with DILI with an overall mortality of 9.7%. If the ALF is unresponsive to medical treatment, liver transplantation has shown promising results and can avoid progression of complications. DILI can be a serious medical condition in patients receiving antituberculosis drugs. If ALF develops and is unresponsive to medical treatment, liver transplantation should be considered as the treatment of choice.
... In a recent systematic review of DRESS syndrome in a pediatric population, the authors found 30 different drugs associated with this disease (2), but in this review, the antituberculosis medication isoniazid was not included as a causative agent of DRESS (3,4). ...
DRESS syndrome is defined as drug-induced hypersensitivity syndrome with rash, eosinophilia, and systemic symptoms. This syndrome is mostly associated with anticonvulsants, antibacterial and anti-inflammatory drugs. DRESS syndrome is a rare disease and is more frequently seen in adults. We present the first case report of DRESS syndrome in an 8-year-old girl, after 3 months of treatment with isoniazid and rifampicin. After discontinuation of drugs and a short course of prednisolone the girl recovered. After 5 years of follow-up, she is healthy and has no complaints but patch tests with isoniazid and rifampicin remain positive. The reported case emphasizes the importance of thorough medical history and including drug reactions in differential diagnosis.
... Tuberculosis is one of the infectious diseases that threaten human health [1]. According to WHO statistics, there were 10.4 million new tuberculosis cases worldwide before 2016, with about 1.6 million deaths [2]. ...
Objective. To explore the clinical value of the specific plasma cell detection and specific T lymphocyte detection test in diagnosing hypersensitivity caused by antituberculosis drugs. Methods. A total of 266 patients with pulmonary tuberculosis who developed hypersensitivity during the treatment of primary pulmonary tuberculosis in our hospital and 266 patients without hypersensitivity during the treatment of pulmonary tuberculosis in our hospital were selected as the control group. The admission time is from January 2013 to June 2020. The specific plasma cell test and specific T lymphocyte test were used as the criteria to determine which drugs induced hypersensitivity, and the diagnostic value of these two methods in the diagnosis of hypersensitivity induced by four first-line antituberculosis drugs (isoniazid (INH), ethambutol (EMB), rifampicin (RFP), and pyrazinamide (PZA)) was analyzed. Results. The sensitivity of the specific plasma cell test in the diagnosis of hypersensitivity induced by INH, EMB, RFP, and PZA was 63.42%, 51.20%, 47.81%, and 56.37%, respectively, and the specificity was 95.33%, 99.87%, 96.52%, and 99.99%, respectively. The sensitivity of the specific T lymphocyte test in the diagnosis of hypersensitivity induced by INH, EMB, RFP, and PZA was 66.47%, 52.88%, 49.91%, and 58.54%, respectively, and the specificity was 97.28%, 99.99%, 98.38%, and 100.00%, respectively. Conclusion. The specific plasma cell test and specific T lymphocyte test have high specificity in the diagnosis of hypersensitivity caused by antituberculosis drugs, and the specific T lymphocyte test is better than the specific plasma cell test. It is of great significance to guide the clinical application of antituberculosis drugs.
... Tuberculosis is one of the infectious diseases that threaten human health [1]. According to WHO statistics, there were 10.4 million new tuberculosis cases worldwide before 2016, with about 1.6 million deaths [2]. ...
Objective
To explore the clinical value of the specific plasma cell detection and specific T lymphocyte detection test in diagnosing hypersensitivity caused by antituberculosis drugs.
Methods
A total of 266 patients with pulmonary tuberculosis who developed hypersensitivity during the treatment of primary pulmonary tuberculosis in our hospital and 266 patients without hypersensitivity during the treatment of pulmonary tuberculosis in our hospital were selected as the control group. The admission time is from January 2013 to June 2020. The specific plasma cell test and specific T lymphocyte test were used as the criteria to determine which drugs induced hypersensitivity, and the diagnostic value of these two methods in the diagnosis of hypersensitivity induced by four first-line antituberculosis drugs (isoniazid (INH), ethambutol (EMB), rifampicin (RFP), and pyrazinamide (PZA)) was analyzed.
Results
The sensitivity of the specific plasma cell test in the diagnosis of hypersensitivity induced by INH, EMB, RFP, and PZA was 63.42%, 51.20%, 47.81%, and 56.37%, respectively, and the specificity was 95.33%, 99.87%, 96.52%, and 99.99%, respectively. The sensitivity of the specific T lymphocyte test in the diagnosis of hypersensitivity induced by INH, EMB, RFP, and PZA was 66.47%, 52.88%, 49.91%, and 58.54%, respectively, and the specificity was 97.28%, 99.99%, 98.38%, and 100.00%, respectively.
Conclusion
The specific plasma cell test and specific T lymphocyte test have high specificity in the diagnosis of hypersensitivity caused by antituberculosis drugs, and the specific T lymphocyte test is better than the specific plasma cell test. It is of great significance to guide the clinical application of antituberculosis drugs.
