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DRESS Syndrome (Drug Reaction with Eosinophilia)

Severe drug hypersensitivity with rash, fever, eosinophilia and visceral involvement

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is DRESS Syndrome (Drug Reaction with Eosinophilia)?

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome, also called drug-induced hypersensitivity syndrome (DIHS), is a severe idiosyncratic drug reaction with latency of 2-8 weeks after drug exposure. It manifests with a triad of rash, fever and internal organ involvement, classically with HHV-6 reactivation.

Common culprits include aromatic anticonvulsants (carbamazepine, phenytoin, lamotrigine), allopurinol, sulfonamides, vancomycin, dapsone and minocycline. The RegiSCAR scoring criteria aid diagnosis. Hepatitis is the most common visceral involvement; nephritis, myocarditis, pneumonitis and thyroiditis may complicate later. Long-term autoimmune sequelae are increasingly recognized.

Symptoms

Diffuse morbilliform rash 2-8 weeks after drug start
High fever above 38.5°C
Facial edema (pathognomonic)
Generalized lymphadenopathy
Pharyngitis and dysphagia
Hepatomegaly with elevated liver enzymes
Eosinophilia and atypical lymphocytes
Pruritus and skin desquamation

Risk Factors

HLA-B*57:01 (abacavir)
HLA-B*15:02 (carbamazepine in Asians)
HLA-B*58:01 (allopurinol)
HLA-A*31:01 (carbamazepine in Caucasians)
HHV-6 or other herpesvirus reactivation
Slow acetylator phenotype
Chronic kidney disease (allopurinol)
Concurrent autoimmune disease

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Diffuse rash 2-8 weeks after starting new medication
  • Fever with rash and facial swelling
  • Lymph node enlargement with rash
  • Yellowing of skin or eyes (jaundice)
  • Decreased urine output
  • Severe pruritus or skin shedding
  • Sore throat with palpable nodes after drug exposure

Treatment Methods

01
Immediate withdrawal of suspect drug
02
RegiSCAR score calculation for diagnostic confirmation
03
Hospitalization with multidisciplinary monitoring
04
Systemic corticosteroids (prednisone 1-1.5 mg/kg/day) tapered slowly over 6-12 weeks
05
Topical high-potency steroids and emollients for skin
06
IVIG 2 g/kg total over 5 days for severe organ involvement
07
Cyclosporine or mycophenolate as steroid-sparing agents
08
Avoidance of structurally related drugs lifelong
09
Long-term thyroid and autoimmune surveillance

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.