D3.58 - Drug-Induced Enterocolitis Syndrome (DIES) Associated to Amoxicillin and Amoxicillin-Clavulanic Acid: A Growing Concern at a Tertiary Hospital
Case report
Drug-Induced Enterocolitis Syndrome (DIES), firstly described in 2014, is a non-IgE-mediated hypersensitivity reaction (HSR), characterized by delayed and severe gastrointestinal symptoms following the ingestion of the culprit drug. While its mechanism/pathophysiology remains poorly understood, diagnosis currently relies on clinical criteria. DIES is a rare entity, with the latest literature review identifying only 22 patients worldwide associated to amoxicillin (AX), amoxicillin-clavulanic acid (AX/CL), pantoprazole, and paracetamol.
We report five cases of DIES diagnosed between 2020 and 2024. All patients were women aged 36 to74 years, with no relevant prior medical history. These patients were investigated for reproducible episodes of gastrointestinal manifestations following the ingestion of AX (2 cases) and AX/CL (3 cases). Specific IgE levels for penicillin G, penicillin V, and amoxicillin were measured and <0.10kU/L in 80%. Skin prick and intradermal tests (IDT)with immediate and delayed readings were performed in three patients and one exhibited immediate positive IDT to PPL and MDM. All five patients underwent an oral challenge, which yielded positive results with gastrointestinal manifestations occurring 1h to 4 hours after the last dose of the drug. Details concerning the reactions and the study conducted in each patient are described in Table 1.
Positive PPL and MDM IDT has not been described as a characteristic of DIES but was observed in one of our patients. However, skin tests have not been consistently performed in previously described cases.
In this study we present the largest cohort of DIES cases from a single hospital. Our findings underscore the importance of clinical awareness about DIES and the urgent need for a better understanding of this entity, which can present with severe manifestations but may also be mistaken for the more common gastrointestinal adverse effects of drugs such as β-lactams.
