DRESS Syndrome
Conveniently, the name is very descriptive – it is a drug reaction with eosinophilia and systemic symptoms -
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DRESS syndrome – a rapid review
Unfortunately, there is no reliable gold standard for the diagnosis of DRESS syndrome. There are a few different published diagnostic criteria... My takeaway is to be on the lookout for rash with at least one systemic and one hematologic symptom.
There are a number of other severe cutaneous drug reactions that will present with a fever and a rash, including Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and erythroderma.
Resources
DRESS: What does the emergency physician need to know?
Since DRESS syndrome can have such a varied presentation, one important differentiation that should be made is between DRESS and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.
EM@3AM – Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
A hypersensitivity reaction characterized by a drug eruption +/- fever, pruritus, pharyngitis, cough, malaise, periorbital edema, headache, otalgia, rhinorrhea, and/or oral ulcers, typically beginning 2-4 weeks after initiation of the offending agent.
Eosinophils, Poetry, and Distilling Out Truth
Let's get the educational component of the column out of the way. DRESS is a high-mortality, bad dermatological condition. Standing for drug reaction with eosinophilia and systemic symptoms, it is an idiosyncratic response to certain drugs, most commonly anticonvulsants and allopurinol, with a long latency (two to eight weeks), characterized by fever, lymphadenopathy, a widespread maculopapular evolving into a vesicular and destructive rash, and any variety of multiorgan dysfunctions and failures.
The DRESS Syndrome: The Great Clinical Mimicker
The life-threatening DRESS (drug rash with eosinophilia and systemic symptoms) syndrome is characterized by the presence of at least three of the following findings: fever, exanthema, eosinophilia, atypical circulating lymphocytes, lymphadenopathy and hepatitis. This syndrome is difficult to diagnose, as many of its clinical features mimic those found with other serious systemic disorders.
Time is skin: what does the emergency physician need to know about DRESS?
Unlike syndromes that may develop due to other drugs, DRESS syndrome customarily commences 2-8 weeks after the commencement of the drug, and symptoms perpetuate to progress after discontinuation of the responsible drug. Symptoms such as fever, lymphadenopathy, hematological disorders, maculopapular rash and internal organ involvement are common in this syndrome.
DRESS syndrome – a rapid review
My takeaway is to be on the lookout for rash with at least one systemic and one hematologic symptom.
DRESS Syndrome Foundation
We are a collaborative network of patients, families, researchers, and physicians dedicated to educating the public and medical communities about the severe adverse drug reaction, D.R.E.S.S. Syndrome.
Dermatology Advisor
The term drug rash with eosinophilia and systemic symptoms (DRESS) was introduced in the mid-1990s to refer to a specific drug-induced hypersensitivity syndrome with well-defined characteristics, namely a skin eruption, hematologic abnormalities and internal organ involvement. The syndrome is heralded by a fever that ranges from 38 to 40°C. The onset of rash coincides with the fever, or it occurs shortly thereafter.
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