D2.242 - Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a Romanian University Hospital

DRESS syndrome is a severe drug allergic reaction characterized by an extensive skin rash in association with internal organs involvement, lymphadenopathy, eosinophilia and atypical lymphocytosis. The latency between drug initiation and onset of skin reaction is prolonged, typically between two to eight weeks. The aim of this study is to evaluate the causes, clinical manifestations and course of patients diagnosed with DRESS in a Romanian University Hospital.

We conducted a retrospective analysis of 15 patients with DRESS syndrome diagnosed in our hospital between September 2019 and August 2024. Demographic characteristics, clinical course, culprit drugs, latency periods, extent of organ involvement, laboratory results, pathological findings, complications and outcome data were collected.

We used the RegiSCAR's scoring system to classify the cases. Detection of human herpes virus (HHV-6) and cytomegalovirus (CMV) infection was not performed.

There were identified 15 cases (9 males and 6 females) of DRESS syndrome. The mean age of the patiens was 56,9 (range 26-86). All the patients were diagnosed by allergy consultant and treated in different departments of our hospital. Carbamazepine was the leading cause (6 cases) followed closely by vancomycin (5 cases), allopurinol (3 cases) and lamotrigine (1 case). The latency period between the administration of causative drugs and the development of the manifestation of DRESS ranged between 7 and 60 days. Eosinophilia was found in 12 patients (80%) in addition with atypical lymphocytosis (n=4, 26%) and thrombocytopenia (n=2, 13%). Patients with mild DRESS and no important internal organ involvement were treated with topical high potency corticosteroids. Those with moderate or severe disease were treated with systemic corticosteroids and antihistamines, most of them showing good clinical outcomes. Only one patient died due to sepsis arising from long-term high-dose systemic corticosteroid treatment.

This study is a retrospective analysis of collected data of 15 patients with DRESS syndrome in an University Hospital over a period of 5 years. As expected, anticonvulsant Carbamazepine was the most common culprit drug, but we identified a higher than reported prevalence of vancomycin-induced DRESS syndrome due to increased use of this antibiotic in our hospital. The outcome was good, most of patients being diagnosed with mild and moderate DRESS. The proportion of complete recovery was 93,3%. All patients were educated about the need for strict avoidance of the causative drug and cross-reacting drugs.