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DRESS Drug Reaction with Eosinophilia and Systemic Symptoms THE SHORT VERSION: - Drug-induced hypersensitivity reaction o Antiepileptics and allopurinol- Life threatening- Look for: o Rash (morbiliform) o Diffuse lymphadenopathy o Diffuse facial edema (ask the pt as this may not be obvious on exam and something they forget to mention) o Visceral involvement - Liver (typically mild, can be severe liver failure) - Kidneys (check Cr and BUN) - Lungs (hypoxemia, pneumonitis, pleural effusion)- Typically resolves in weeks after offending agent is removed- Treat supportively (if renal/lung involvement consider corticosteroids) THE LONG VERSION THAT YOU LIKELY WONT REMEMBER AND WILL HAVE TO LOOK UP WHEN YOU SEE A PATIENT WITH DRESS: - Drug-induced hypersensitivity reaction - Life threatening o 80% drug related o Occurs 2-8 weeks after initiation of medication o Antiepileptic agents (eg, carbamazepine, lamotrigine, phenytoin, phenobarbital) and allopurinol are the most frequently reported causes o 10-20% a drug relationship cannot be established - Look for: 1
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