D3.375 - Delayed-Type Drug Reactions in Pediatric Patients: Clinical Features and Management

Drug-induced cutaneous adverse reactions (CADRs) range from mild maculopapular exanthema (MPE) to severe, life-threatening mucocutaneous syndromes such as drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Pediatric data on delayed-type drug reactions are limited. This study aimed to evaluate the clinical characteristics, etiologic agents, management strategies, and outcomes of delayed-type drug reactions in children followed at a tertiary pediatric center.

This retrospective study included 33 pediatric patients diagnosed with delayed-type drug reactions between January 2013 and December 2024. Demographic data, drug exposure, clinical manifestations, laboratory and histopathologic findings, treatments, and long-term outcomes were retrospectively reviewed. RegiSCAR criteria were used for DRESS, EuroSCAR for AGEP, and SCORTEN for risk assessment in SJS/TEN.

The median age was 9 years (range: 9 days–16 years); 17 patients were female. The most frequent diagnosis was MPE (n=18, 54.5%), followed by DRESS (n=5, 15.1%), SJS/TEN (n=3, 9.1%), AGEP/ALEP (n=3, 9.1%), erythema multiforme (n=2, 6.0%), and SDRIFE (n=2, 6.0%). Antibiotics and antiepileptic drugs were the most common causative agents. Systemic corticosteroids were administered in moderate-to-severe cases, and intravenous immunoglobulin was used in patients with DRESS and SJS/TEN. Four patients died due to underlying primary diseases; no drug reaction–related mortality was observed.

Delayed-type drug reactions in children show heterogeneous clinical presentations. Although MPE is the most common phenotype, severe reactions may result in significant morbidity. Early recognition and a multidisciplinary approach are crucial for optimal outcomes.