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DRESS Syndrome

Vanessa Cardy, MD

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A disorder with fever and rash, no big deal. Internal organ inflammation, big deal. 10% mortality?!? Now you’ve got my attention.

When is a rash not just a rash? When it’s DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) -a  potentially fatal drug reaction to meds we prescribe every day. Minocycline, lamotrigine, allopurinol and phenytoin are but a few of the offenders that can lead to this potentially fatal disorder.

Cacoub, Patrice, et al. "The DRESS syndrome: a literature review." The American journal of medicine 124.7 (2011): 588-597.

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Simonart, S. Tas T. "Management of drug rash with eosinophilia and systemic symptoms (DRESS syndrome): an update." Dermatology 206 (2003): 353-356.

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Vanessa C. -

So a little update on this... the other day I ended up seeing a patient who had DRESS syndrome... I couldn't quite believe it at first but a little voice kept saying, is this DRESS syndrome? The ID and Derm folks agreed... Crazy... But why I wanted to write this update is because there was a little caveat to this kid's presentation. He had severe leukopenia (with an ANC of zero and very low eosinophils) so meant that his diagnosis was delayed for a day or so. Eosinophils didn't pop out at me so I let it go at first... After chatting with the derm folks it turns out that you can have DRESS without eosinophilia if your white count is low. So just as you can have afebrile febrile seizures (makes me want to cry) you can have Drug Reaction with Eosinophilia and Systemic Sypmtoms WITHOUT esosinophilia. Curses I say, curses. So it could be called DRSS syndrome.... so much for acronyms.

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DRESS Syndrome Full episode audio for MD edition 7:02 min - 3 MB - M4A