Acta Scientific Pharmacology

Case Report Volume 4 Issue 2

Bacterial Infection May Trigger DRESS Syndrome: An Exceptional Case of Delayed Hypersensitivity Reaction Occurring 22 Months After Allopurinol Therapy

Ines Souilem*, Fatma Zgolli, Ghozlane Lakhoua, Sarrah Kastalli, Riadh Daghfous and Sihem El Aidli

National Center of Pharmacovigilance, Research Unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunisia

*Corresponding Author: Ines Souilem, National Center of Pharmacovigilance, Research Unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunisia.

Received: May 29, 2023 Published: June 14, 2023

Abstract

Drug-induced hypersensitivity syndrome also known as DRESS syndrome is considered as a severe and potentially life-threatening adverse drug reaction. The pathogenesis of DRESS syndrome is still partially understood. Prior research has implicated viral infection or reactivation, specifically, human herpes viruses 6 and 7, Epstein-Barr virus and cytomegalovirus.

We report a case of DRESS syndrome induced by allopurinol occurring 22 months after starting the treatment and which might have been triggered by concomitant infections.

A 72-year-old man was put on allopurinol in February 2021. Twenty months later, he was hospitalized for Klebsiella urinary tract infection associated with erysipelas that had evolved well after two weeks of antibiotherapy. On November 20, he presented a second episode of Enterococcus faecalis urinary tract infection. On December 5, he developed a pruritic maculopapular rash with fever (39.5°C). Skin examination showed a generalized infiltrated erythematous maculopapular eruption and facial edema. Complete blood counts showed total leucocyte count at 10.6 × 103/µl with eosinophils at 1.58 × 103/µl (14.9%). Histological findings were compatible with DRESS syndrome. Allopurinol was stopped. Skin condition improved within a month.

A prolonged delay between the start of treatment and the appearance of a febrile rash should never exclude the diagnosis of Dress syndrome or delay its management.

 Keywords: DRESS Syndrome; Allopurinol; Infection; Pharmacovigilance; Hypersensitivity

References

  1. Choudhary S., et al. “Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome”. Journal of Clinical and Aesthetic Dermatology 6 (2013).
  2. Tohyama M., et al. “Association of human herpesvirus 6 reactivation with the flaring and severity of drug-induced hypersensitivity syndrome”. British Journal of Dermatology 157 (2007): 934‑9
  3. Sasidharanpillai S., et al. “RegiSCAR DRESS (drug reaction with eosinophilia and systemic symptoms) validation scoring system and Japanese consensus group criteria for atypical drug-induced hypersensitivity syndrome (DiHS): A comparative analysis”. Indian Dermatology Online 13 (2022): 40.
  4. Miremont-Salamé G., et al. “Causality assessment in pharmacovigilance: The French method and its successive updates”. Therapies 71 (2016): 179‑1
  5. Myers CM., et al. “Allopurinol-Induced Drug Reaction With Eosinophilia and Systemic Symptoms: A Case Report”. Advanced Emergency Nursing Journal 42 (2020): 108‑1
  6. Koike M., et al. “Viruses may trigger allopurinol hypersensitivity syndrome”. Clinical Kidney Journal 1 (2008): 273‑27
  7. Descamps V., et al. “Le DRESS (drug reaction with eosinophilia and systemic symptoms): une synergie médicaments-virus qui peut conduire en reanimation”. Réanimation. mai 20 (2011): 223‑22
  8. Hewitt N., et al. “Drug reaction with eosinophilia and systemic symptoms associated with H1N1 vaccination”. Internal Medicine Journal 42 (2012): 1365‑

Citation

Citation: Ines Souilem., et al. “Bacterial Infection May Trigger DRESS Syndrome: An Exceptional Case of Delayed Hypersensitivity Reaction Occurring 22 Months After Allopurinol Therapy". Acta Scientific Pharmacology 4.2 (2023): 19-21.

Copyright

Copyright: © 2023 Ines Souilem., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate36%
Acceptance to publication20-30 days

Indexed In


News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is June 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US