Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction caused by certain medications like carbamazepine. It involves a rash, fever, swelling of lymph nodes and organs like the liver, and high eosinophil counts. DRESS is diagnosed based on clinical features and test results showing eosinophilia, atypical lymphocytes, and elevated liver enzymes. Treatment involves promptly stopping the causative drug, supportive care, and sometimes corticosteroids. Complications can include autoimmune diseases or organ failure. Prognosis is generally good if the offending drug is identified and stopped early.
This document discusses DRESS syndrome, which stands for drug reaction with eosinophilia and systemic symptoms. It is a type of severe cutaneous adverse drug reaction characterized by a rash, fever, swelling of lymph nodes, and internal organ involvement. Common causes include certain anti-gout, anti-epilepsy, and antibiotic drugs. Signs and symptoms appear 2-8 weeks after starting the culprit drug and may persist after stopping treatment. Diagnosis involves identifying a temporal association with drug intake. Treatment involves discontinuing the drug, supportive care, and sometimes corticosteroids. Prognosis is generally good but mortality is estimated at around 8%.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
This case report describes a 24-year-old man who presented with fever, rash, abdominal pain, and vomiting. He had been taking carbamazepine for seizures. His symptoms and lab results met the criteria for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as drug hypersensitivity syndrome. DRESS is caused by certain drugs and is characterized by fever, rash, eosinophilia, and involvement of internal organs like the liver or lungs. Carbamazepine was withdrawn and steroids were started, leading to improvement. The report reviews the characteristics, diagnosis, and treatment of DRESS, noting it is important to identify the causative drug and avoid re-
Drug-induced hypersensitivity syndrome (DIHS)/Drug reaction with eosinophilia and systemic symptoms (DRESS)
Presented by Pongsawat Rodsaward, MD.
December 17, 2021
Stevens-Johnson syndrome is a life-threatening skin condition characterized by extensive necrosis and separation of the epidermis from the dermis. It exists on a spectrum of severity from Steven Johnson Syndrome (<10% body surface area involvement) to Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (10-30% involvement) and Toxic Epidermal Necrolysis (>30% involvement). It is typically caused by hypersensitivity drug reactions or infections and presents with painful erosions and blistering of the skin and mucous membranes that can lead to vision loss, respiratory failure, or death in severe cases. Treatment focuses on stopping the offending agent, supportive care in intensive care units, wound care of d
Drug reaction with eosinophilia and systemic symptoms & acute generalized exanthematous pustulosis 2019
Presented by Nattasasi Suchamalawong, MD.
November 15, 2019
The document discusses two types of adverse cutaneous drug reactions: drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). DRESS is characterized by a skin eruption, hematologic abnormalities like eosinophilia, and internal organ involvement. It has a delayed onset and can cause long-term complications. AGEP presents with sudden onset of fever and a pustular rash, but does not involve internal organs. Both can be life-threatening but typically resolve after stopping the culprit drug.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction caused by certain medications like carbamazepine. It involves a rash, fever, swelling of lymph nodes and organs like the liver, and high eosinophil counts. DRESS is diagnosed based on clinical features and test results showing eosinophilia, atypical lymphocytes, and elevated liver enzymes. Treatment involves promptly stopping the causative drug, supportive care, and sometimes corticosteroids. Complications can include autoimmune diseases or organ failure. Prognosis is generally good if the offending drug is identified and stopped early.
This document discusses DRESS syndrome, which stands for drug reaction with eosinophilia and systemic symptoms. It is a type of severe cutaneous adverse drug reaction characterized by a rash, fever, swelling of lymph nodes, and internal organ involvement. Common causes include certain anti-gout, anti-epilepsy, and antibiotic drugs. Signs and symptoms appear 2-8 weeks after starting the culprit drug and may persist after stopping treatment. Diagnosis involves identifying a temporal association with drug intake. Treatment involves discontinuing the drug, supportive care, and sometimes corticosteroids. Prognosis is generally good but mortality is estimated at around 8%.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
This case report describes a 24-year-old man who presented with fever, rash, abdominal pain, and vomiting. He had been taking carbamazepine for seizures. His symptoms and lab results met the criteria for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as drug hypersensitivity syndrome. DRESS is caused by certain drugs and is characterized by fever, rash, eosinophilia, and involvement of internal organs like the liver or lungs. Carbamazepine was withdrawn and steroids were started, leading to improvement. The report reviews the characteristics, diagnosis, and treatment of DRESS, noting it is important to identify the causative drug and avoid re-
Drug-induced hypersensitivity syndrome (DIHS)/Drug reaction with eosinophilia and systemic symptoms (DRESS)
Presented by Pongsawat Rodsaward, MD.
December 17, 2021
Stevens-Johnson syndrome is a life-threatening skin condition characterized by extensive necrosis and separation of the epidermis from the dermis. It exists on a spectrum of severity from Steven Johnson Syndrome (<10% body surface area involvement) to Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (10-30% involvement) and Toxic Epidermal Necrolysis (>30% involvement). It is typically caused by hypersensitivity drug reactions or infections and presents with painful erosions and blistering of the skin and mucous membranes that can lead to vision loss, respiratory failure, or death in severe cases. Treatment focuses on stopping the offending agent, supportive care in intensive care units, wound care of d
Drug reaction with eosinophilia and systemic symptoms & acute generalized exanthematous pustulosis 2019
Presented by Nattasasi Suchamalawong, MD.
November 15, 2019
The document discusses two types of adverse cutaneous drug reactions: drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). DRESS is characterized by a skin eruption, hematologic abnormalities like eosinophilia, and internal organ involvement. It has a delayed onset and can cause long-term complications. AGEP presents with sudden onset of fever and a pustular rash, but does not involve internal organs. Both can be life-threatening but typically resolve after stopping the culprit drug.
This document discusses drug eruptions, including their mechanisms and presentations. It provides details on common drug reactions involving specific medications such as antibiotics, oral contraceptives, steroids, and anticonvulsants. It describes some typical reaction patterns and treatments. Drug eruptions can be allergic or non-allergic, and involve a variety of skin manifestations. Making the correct diagnosis requires considering the patient's full drug history and ruling out other potential causes.
Atopic dermatitis is a chronic inflammatory skin disease associated with respiratory allergies. It is characterized by recurrent eczematous lesions and intense itch. Genetic factors like filaggrin mutations cause skin barrier defects allowing allergens and microbes to trigger immune responses. The disease involves type 2 immunity cytokines activating neurons to produce itch. Staphylococcus aureus colonization exacerbates inflammation. Clinical features include erythematous patches and plaques with lichenification in chronic cases.
Cutaneous involvement is very common in the different types of vasculitis. Skin lesions may be the only manifestation or may occur in the context of systemic disease
Psoriasis and Management in Primary CareKochi Chia
1. Psoriasis is a chronic, immune-mediated skin disorder characterized by patches of abnormal skin that are typically red, itchy, and scaly. It occurs worldwide and has various clinical subtypes defined by the appearance of the rashes.
2. The pathogenesis of psoriasis involves an interplay between immune system dysfunction, epidermal keratinocyte hyperproliferation, and vascular changes. Genetic and environmental factors contribute to its development.
3. Psoriasis is associated with increased risks of comorbidities like psoriatic arthritis, cardiovascular disease, and metabolic syndrome. Treatment involves topical agents for mild cases and progresses to phototherapy, systemic drugs, and bi
Psoriasis is a chronic, inflammatory skin condition that causes red scaly patches to appear on the skin. The most common form is plaque psoriasis, which accounts for 80-90% of cases, appearing as raised, red patches covered with silvery scales. Psoriasis occurs when skin cells multiply up to 10 times faster than normal. It is believed to be both a disorder of skin cell growth and an immune-mediated disease driven by T cells and cytokines. Psoriasis has no cure but can be managed with topical treatments and phototherapy. It affects the joints in 10-20% of cases (psoriatic arthritis).
Erythrodermic psoriasis case presentationRumana Hameed
- The patient presented with erythrodermic psoriasis, a severe form of psoriasis affecting most of the body surface. Symptoms included redness, scaling, and itching all over the body.
- A skin biopsy confirmed psoriatic erythroderma. The patient was started on methotrexate and folic acid for immunosuppression along with antibiotics, antihistamines, emollients and corticosteroids to treat symptoms.
- The patient was counseled on lifestyle modifications including avoiding smoking and alcohol, taking oatmeal baths, moisturizing skin, and minimizing sun exposure to manage their condition.
Eczema, also known as dermatitis, is a common skin condition affecting 20% of patients referred to clinics. It is characterized by redness, swelling, blistering, crusting, and flaking in areas with poorly defined borders. Histologically, eczema shows inflammation of the epidermis and dermis. The causes include allergic and irritant contact dermatitis. Treatment depends on the severity and includes emollients, topical corticosteroids, wet wrap dressings, systemic antibiotics, and avoidance of exacerbating factors. Atopic eczema, the most common form, has a genetic component and usually starts in childhood.
Cutaneous drug reactions are adverse skin reactions caused by medications. They range from mild rashes to potentially life-threatening conditions like toxic epidermal necrolysis. Most cutaneous drug reactions are immune-mediated and occur within a few weeks of starting a medication. Management involves promptly withdrawing the offending drug, providing supportive care, and occasionally systemic corticosteroids for more severe reactions to prevent complications and mortality. The prognosis depends on the specific reaction, with most mild rashes resolving on their own while toxic epidermal necrolysis has a high mortality rate of around 50%.
This document discusses Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and erythema multiforme (EM). It defines SJS and TEN as rare, life-threatening diseases caused by extensive keratinocyte cell death. SJS is distinguished from TEN based on the extent of epidermal detachment. The document outlines risk factors, pathogenesis, clinical features, investigations, differential diagnosis, management including wound care, and complications of SJS, TEN and EM. Management involves discontinuing causative drugs, fluid and electrolyte replacement, nutritional support, wound dressing, and in some cases corticosteroids, cyclosporine or IV immunoglobulins. Progn
hanifin and rajka criteria, entymology, definition of AD, atopy, etiopathogenesis of AD, genetics in AD, filaggrin, epidermal barrier dysfunction, atopic march, hygiene hypothesis, infantile phase of AD, childhood phase of AD, adult phase of AD, pityriasis alba, denne morgan folds, dirty neck appearence, nipple dermatitis, hanifin and rajka criteria, UK refinement of hanifin and rajka criteria, millenium criteria of AD, japanese dermatological association criteria, management of AD, wet wrap therapy,
Lyell's syndrome or Toxic epidermal necrolysisSharon Jessy
Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a rare, life-threatening skin condition usually caused by an adverse drug reaction. It causes the top layer of skin to detach from the lower layers all over the body, leaving the body susceptible to severe infection. TEN progresses from a rash and blisters to large areas of skin sloughing off and can involve mucous membranes. It has overall mortality rate of around 30% and treatment aims to discontinue the causative drug and provide supportive care to protect the skin and monitor fluid and electrolyte balance.
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...Prof Dr Bashir Ahmed Dar
Dr Bashir ahmed dar associate professor medicine chinkipora sopore kashmir presently working in medical college malaysia describes rheumatoid arthritis which is a autoimmune disorder in which Immune system identifies the synovial membrane as "foreign" and begins attacking it.
Pruritus, or itch, is a sensation that provokes the desire to scratch. Chronic pruritus lasts more than 6 weeks and can be caused by skin diseases or systemic diseases. Itch is transmitted through unmyelinated C fibers and is a distinct sensation from pain. Scratching provides temporary relief by stimulating myelinated fibers or damaging sensory nerve endings. Management of pruritus involves general skin care, topical agents like corticosteroids, calcineurin inhibitors, local anesthetics, and antihistamines, as well as treating any underlying cause.
Drug eruptions can mimic various skin conditions and are often caused by medications. The document defines adverse drug reactions and lists common inducing drugs. It describes several types of drug eruptions like maculopapular eruptions, urticaria, angioedema, DRESS syndrome, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, fixed drug eruptions, leukocytoclastic vasculitis, photosensitivity, erythroderma, erythema nodosum, acute generalized exanthematous pustulosis, and anticoagulant skin necrosis. It emphasizes the importance of history, physical exam, potential lab tests, identifying the culprit drug
DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe cutaneous adverse drug reaction characterized by a skin rash, hematologic abnormalities including eosinophilia and lymphadenopathy, and internal organ involvement. It is caused by certain drugs like antiepileptics and allopurinol. The diagnosis is based on clinical criteria including a rash involving over 50% of the body surface area, fever, organ dysfunction, and elevated eosinophil counts. Treatment involves immediate withdrawal of the culprit drug and supportive care, with corticosteroids for severe organ involvement. The prognosis is generally good if recognized and managed promptly.
This document provides information about severe cutaneous adverse drug reactions (SCARs) including Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). It defines each condition, discusses their epidemiology, etiology, clinical features, investigations, treatment and prognosis. SJS/TEN is characterized by blistering and sloughing of the skin and mucous membranes. DRESS presents with rash and systemic involvement of organs. AGEP features non-follicular sterile pustules localized to flexural areas. Management involves identifying and stopping the culprit drug,
This document provides information on urticaria (hives), including definitions, epidemiology, pathogenesis, classification, and specific types. Some key points:
- Wheals are central swellings surrounded by erythema that itch or burn and resolve within 24 hours. Angioedema causes swelling below the skin that takes longer to resolve.
- Urticaria prevalence is 15-25% lifetime and chronic urticaria affects 1% annually, more common in adults and women.
- Pathogenesis involves skin mast cell degranulation in response to triggers like allergens, autoantibodies, neuropeptides.
- Classification includes acute (<6 weeks), chronic (>6 weeks),
This document discusses the use of homeopathic prophylaxis or nosodes to help prevent the spread of COVID-19. It provides several examples from the past where homeopathic prophylaxis was successfully used to reduce epidemics of diseases like influenza, cholera, smallpox, and leptospirosis. It notes that a pharmacy has created a nosode from a patient exhibiting COVID-19 symptoms to potentially be used preventatively by those interested in a homeopathic approach. Historical evidence is presented to support the use of homeopathic prophylaxis in epidemics while complying with social distancing guidelines.
This document discusses drug eruptions, including their mechanisms and presentations. It provides details on common drug reactions involving specific medications such as antibiotics, oral contraceptives, steroids, and anticonvulsants. It describes some typical reaction patterns and treatments. Drug eruptions can be allergic or non-allergic, and involve a variety of skin manifestations. Making the correct diagnosis requires considering the patient's full drug history and ruling out other potential causes.
Atopic dermatitis is a chronic inflammatory skin disease associated with respiratory allergies. It is characterized by recurrent eczematous lesions and intense itch. Genetic factors like filaggrin mutations cause skin barrier defects allowing allergens and microbes to trigger immune responses. The disease involves type 2 immunity cytokines activating neurons to produce itch. Staphylococcus aureus colonization exacerbates inflammation. Clinical features include erythematous patches and plaques with lichenification in chronic cases.
Cutaneous involvement is very common in the different types of vasculitis. Skin lesions may be the only manifestation or may occur in the context of systemic disease
Psoriasis and Management in Primary CareKochi Chia
1. Psoriasis is a chronic, immune-mediated skin disorder characterized by patches of abnormal skin that are typically red, itchy, and scaly. It occurs worldwide and has various clinical subtypes defined by the appearance of the rashes.
2. The pathogenesis of psoriasis involves an interplay between immune system dysfunction, epidermal keratinocyte hyperproliferation, and vascular changes. Genetic and environmental factors contribute to its development.
3. Psoriasis is associated with increased risks of comorbidities like psoriatic arthritis, cardiovascular disease, and metabolic syndrome. Treatment involves topical agents for mild cases and progresses to phototherapy, systemic drugs, and bi
Psoriasis is a chronic, inflammatory skin condition that causes red scaly patches to appear on the skin. The most common form is plaque psoriasis, which accounts for 80-90% of cases, appearing as raised, red patches covered with silvery scales. Psoriasis occurs when skin cells multiply up to 10 times faster than normal. It is believed to be both a disorder of skin cell growth and an immune-mediated disease driven by T cells and cytokines. Psoriasis has no cure but can be managed with topical treatments and phototherapy. It affects the joints in 10-20% of cases (psoriatic arthritis).
Erythrodermic psoriasis case presentationRumana Hameed
- The patient presented with erythrodermic psoriasis, a severe form of psoriasis affecting most of the body surface. Symptoms included redness, scaling, and itching all over the body.
- A skin biopsy confirmed psoriatic erythroderma. The patient was started on methotrexate and folic acid for immunosuppression along with antibiotics, antihistamines, emollients and corticosteroids to treat symptoms.
- The patient was counseled on lifestyle modifications including avoiding smoking and alcohol, taking oatmeal baths, moisturizing skin, and minimizing sun exposure to manage their condition.
Eczema, also known as dermatitis, is a common skin condition affecting 20% of patients referred to clinics. It is characterized by redness, swelling, blistering, crusting, and flaking in areas with poorly defined borders. Histologically, eczema shows inflammation of the epidermis and dermis. The causes include allergic and irritant contact dermatitis. Treatment depends on the severity and includes emollients, topical corticosteroids, wet wrap dressings, systemic antibiotics, and avoidance of exacerbating factors. Atopic eczema, the most common form, has a genetic component and usually starts in childhood.
Cutaneous drug reactions are adverse skin reactions caused by medications. They range from mild rashes to potentially life-threatening conditions like toxic epidermal necrolysis. Most cutaneous drug reactions are immune-mediated and occur within a few weeks of starting a medication. Management involves promptly withdrawing the offending drug, providing supportive care, and occasionally systemic corticosteroids for more severe reactions to prevent complications and mortality. The prognosis depends on the specific reaction, with most mild rashes resolving on their own while toxic epidermal necrolysis has a high mortality rate of around 50%.
This document discusses Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and erythema multiforme (EM). It defines SJS and TEN as rare, life-threatening diseases caused by extensive keratinocyte cell death. SJS is distinguished from TEN based on the extent of epidermal detachment. The document outlines risk factors, pathogenesis, clinical features, investigations, differential diagnosis, management including wound care, and complications of SJS, TEN and EM. Management involves discontinuing causative drugs, fluid and electrolyte replacement, nutritional support, wound dressing, and in some cases corticosteroids, cyclosporine or IV immunoglobulins. Progn
hanifin and rajka criteria, entymology, definition of AD, atopy, etiopathogenesis of AD, genetics in AD, filaggrin, epidermal barrier dysfunction, atopic march, hygiene hypothesis, infantile phase of AD, childhood phase of AD, adult phase of AD, pityriasis alba, denne morgan folds, dirty neck appearence, nipple dermatitis, hanifin and rajka criteria, UK refinement of hanifin and rajka criteria, millenium criteria of AD, japanese dermatological association criteria, management of AD, wet wrap therapy,
Lyell's syndrome or Toxic epidermal necrolysisSharon Jessy
Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a rare, life-threatening skin condition usually caused by an adverse drug reaction. It causes the top layer of skin to detach from the lower layers all over the body, leaving the body susceptible to severe infection. TEN progresses from a rash and blisters to large areas of skin sloughing off and can involve mucous membranes. It has overall mortality rate of around 30% and treatment aims to discontinue the causative drug and provide supportive care to protect the skin and monitor fluid and electrolyte balance.
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...Prof Dr Bashir Ahmed Dar
Dr Bashir ahmed dar associate professor medicine chinkipora sopore kashmir presently working in medical college malaysia describes rheumatoid arthritis which is a autoimmune disorder in which Immune system identifies the synovial membrane as "foreign" and begins attacking it.
Pruritus, or itch, is a sensation that provokes the desire to scratch. Chronic pruritus lasts more than 6 weeks and can be caused by skin diseases or systemic diseases. Itch is transmitted through unmyelinated C fibers and is a distinct sensation from pain. Scratching provides temporary relief by stimulating myelinated fibers or damaging sensory nerve endings. Management of pruritus involves general skin care, topical agents like corticosteroids, calcineurin inhibitors, local anesthetics, and antihistamines, as well as treating any underlying cause.
Drug eruptions can mimic various skin conditions and are often caused by medications. The document defines adverse drug reactions and lists common inducing drugs. It describes several types of drug eruptions like maculopapular eruptions, urticaria, angioedema, DRESS syndrome, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, fixed drug eruptions, leukocytoclastic vasculitis, photosensitivity, erythroderma, erythema nodosum, acute generalized exanthematous pustulosis, and anticoagulant skin necrosis. It emphasizes the importance of history, physical exam, potential lab tests, identifying the culprit drug
DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe cutaneous adverse drug reaction characterized by a skin rash, hematologic abnormalities including eosinophilia and lymphadenopathy, and internal organ involvement. It is caused by certain drugs like antiepileptics and allopurinol. The diagnosis is based on clinical criteria including a rash involving over 50% of the body surface area, fever, organ dysfunction, and elevated eosinophil counts. Treatment involves immediate withdrawal of the culprit drug and supportive care, with corticosteroids for severe organ involvement. The prognosis is generally good if recognized and managed promptly.
This document provides information about severe cutaneous adverse drug reactions (SCARs) including Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). It defines each condition, discusses their epidemiology, etiology, clinical features, investigations, treatment and prognosis. SJS/TEN is characterized by blistering and sloughing of the skin and mucous membranes. DRESS presents with rash and systemic involvement of organs. AGEP features non-follicular sterile pustules localized to flexural areas. Management involves identifying and stopping the culprit drug,
This document provides information on urticaria (hives), including definitions, epidemiology, pathogenesis, classification, and specific types. Some key points:
- Wheals are central swellings surrounded by erythema that itch or burn and resolve within 24 hours. Angioedema causes swelling below the skin that takes longer to resolve.
- Urticaria prevalence is 15-25% lifetime and chronic urticaria affects 1% annually, more common in adults and women.
- Pathogenesis involves skin mast cell degranulation in response to triggers like allergens, autoantibodies, neuropeptides.
- Classification includes acute (<6 weeks), chronic (>6 weeks),
This document discusses the use of homeopathic prophylaxis or nosodes to help prevent the spread of COVID-19. It provides several examples from the past where homeopathic prophylaxis was successfully used to reduce epidemics of diseases like influenza, cholera, smallpox, and leptospirosis. It notes that a pharmacy has created a nosode from a patient exhibiting COVID-19 symptoms to potentially be used preventatively by those interested in a homeopathic approach. Historical evidence is presented to support the use of homeopathic prophylaxis in epidemics while complying with social distancing guidelines.
This study examined the relationship between symptom onset to admission time (SOAT) and the severity of COVID-19 through a meta-analysis and retrospective analysis. The meta-analysis found that patients with adverse outcomes had a longer SOAT than those without adverse outcomes. The retrospective analysis initially found no significant difference in SOAT between severe and mild COVID-19 patients. However, after adjusting for confounding factors using propensity score matching, patients in the severe group were found to have a longer SOAT. This suggests that shortening SOAT may help reduce progression to severe illness in COVID-19 patients.
APA format 1.5 pages MSN degree 2 references from Walden university brockdebroah
APA format 1.5 pages MSN degree 2 references from Walden university library
Due Thursday March 15, 2018 at 7pm EST
Immune Disorders
Two immune deficiency disorders will be discussed in the following text, human immunodeficiency virus (HIV) and psoriasis. Pathophysiology, drug therapy, and adverse effects will be discussed. Furthermore, variations in each disease process will also be presented. The purpose of this discussion post is to further understand the disease process of HIV and psoriasis.
HIV
Human immunodeficiency virus is a viral infection that targets the CD4-positive Th cells, which are needed for the development of plasma cells and T cells. The result of this cell depletion results in a negative immune response. With the immune system suppression, the development of acquired immunodeficiency syndrome (AIDS) is possible (Huether & McCance, 2017), p. 194).
Drug Therapy
After HIV is diagnosed, the goal of action is to control the virus and prevent the progression to AIDS. Drug therapy is designed to do five things for the patient: suppress the viral load, restore the immune system function, maintain quality of life, prevent HIV related complications, and prevent HIV transmission (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 846).
Medication regimens have been designed and it is important to note the each patient responds differently. The different classes of drug regimens include: nucleoside reverse transcriptase inhibitors (NRTI), nonnucleaoside reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI), fusion inhibitors, integrase trans transfer inhibitors (INSTI), and CCR5 Antagonists.
When using NRTI drugs such as, Ziagen, Videx, Emtriva, Epivir, Zerit, and Retrovir, it is important to know that they prevent the transcription of RNA into DNA (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 849).
When working with NNRTIs drug such as, Rescriptor, Sustiva, Intelence, Viramune, and Edurant, the drug binds to the reverse transcriptase and prevents the conversion of RNA into DNA Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 851).
Protease inhibitors target the cell replication in the later stages. They prevent the development of the polyproteins, which are needed to create new HIV RNA copies. Examples of PIs are Reyataz, Prezista, Lexiva, Crixivan, Kaletra, Viracept, Norvir, Invirase, and Aptivus (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 852).
Fusion inhibitors prevents HIV from entering the cells by blocking the fusion process of the virus to the membrane of the CD4 T cells. Fuzeon is the only available drug from this particular class (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 853).
The INSTIs available for use are Trivicy, Vitekta, and Isentress. These drugs prevent the HIVs DNA from entering the genome of the host cell. They are often used in conjunction with NRTI drugs (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 853).
The final drug class is the CCR5 Antagonists and ...
This study analyzed over 300,000 fractures in 18 bones to identify risk factors for fracture nonunion using a large US health claims database. The overall nonunion rate was 4.9%. Certain fractures like scaphoid, tibia/fibula and femur fractures had nonunion rates over 10%. Multiple risk factors were associated with increased odds of nonunion on multivariate analysis, including open fractures, multiple concurrent fractures, prescription NSAID and opioid use, anticoagulant use, and osteoarthritis with rheumatoid arthritis - all increasing the risk of nonunion by over 50%. The probability of nonunion can be estimated based on patient characteristics and fracture severity available at initial presentation.
A 92-year-old female presented with post renal obstruction and hematuria. She was initially diagnosed with acute cystitis and started on Meropenem on October 31st, then switched to Augmentin on November 4th. On November 5th, she returned to the emergency room with a widespread rash on her trunk and legs. A skin biopsy showed subcorneal pustules and dermal inflammation consistent with acute generalized exanthematous pustulosis, likely caused by Augmentin. Her rash resolved after discontinuing Augmentin and treating with topical steroids.
Low-dose hydroxychloroquine therapy and mortality in hospitalised patients wi...La Verità
This study analyzed data from a nationwide surveillance of 8075 COVID-19 patients hospitalized in Belgium to compare in-hospital mortality between those treated with low-dose hydroxychloroquine (HCQ) monotherapy (2400 mg total over 5 days) and supportive care only. The HCQ-treated group had lower mortality (17.7% vs 27.1%). In a statistical analysis adjusting for demographic and clinical factors, HCQ treatment was independently associated with lower mortality compared to supportive care alone. Subgroup analyses found reduced mortality with HCQ for patients diagnosed both within 5 days and over 5 days from symptom onset.
This document discusses the emerging field of personalized or tailored medicine. It begins with an introduction to personalized medicine, defining it as tailoring medical treatments to an individual's characteristics. The document then covers the history and driving factors behind personalized medicine. It discusses the goals and benefits of personalized medicine, as well as some limitations. Potential applications discussed include pharmacogenetics, pharmacometabonomics, and cancer management. Several examples of personalized cancer treatments and diagnostics are provided. The document emphasizes that a one-size-fits-all approach to medicine is often ineffective and can cause harm, whereas personalized medicine aims to provide each patient with the right treatment.
This study retrospectively analyzed 163 patients treated for spondylodiscitis (spinal infection) between 1992-2000. Patients were divided into 3 treatment groups:
Group A (70 patients) received non-operative treatment including antibiotics and bracing. 8 later required surgery.
Group B (56 patients) underwent posterior decompression alone. 24 later required additional surgery for debridement and stabilization.
Group C (37 patients) received decompression and internal stabilization. Only 6 later required re-operation.
Non-operative treatment was effective for most patients. Decompression alone had a higher re-operation rate compared to decompression with internal stabilization. Overall, surgical treatment improved neurological outcomes compared to non-
Botulinum toxin injections were found to be a useful and safe treatment for reducing self-biting behavior in six patients with Lesch-Nyhan disease. Patients received an average of 20 botulinum toxin injections over 1.5 to 7.1 years, with injections targeting the masticatory muscles, biceps brachii, and other muscles. Of the 119 total injections, 113 (95%) were partially or completely effective in reducing self-biting. Only 3 injections (2.5%) produced adverse effects such as difficulty swallowing or general weakness. Botulinum toxin injections provided an effective treatment option for managing self-injurious behavior in patients with Lesch-Nyhan disease.
This document provides guidelines from the Infectious Diseases Society of America (IDSA) for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Some key points:
1. All patients who present with fever and neutropenia should receive immediate empirical antibiotic therapy with broad-spectrum antibiotics to treat both gram-positive and gram-negative pathogens.
2. Patients should be assessed for risk of complications, with high-risk patients requiring hospitalization and intravenous antibiotics. Low-risk patients may be candidates for oral outpatient therapy.
3. Initial testing should include blood cultures and tests to assess organ function, with additional cultures as clinically indicated. Chest imaging
Treatment with hydroxychloroquine, azithromycin, and combination in patients ...La Verità
This study examined the association between hydroxychloroquine treatment and in-hospital mortality among 2541 COVID-19 patients. When controlling for risk factors, treatment with hydroxychloroquine alone and in combination with azithromycin was associated with a reduction in mortality. Hydroxychloroquine alone showed a 66% reduction in mortality risk and hydroxychloroquine plus azithromycin showed a 71% reduction compared to no treatment. However, prospective randomized trials are still needed to further examine the impact of these drug regimens.
This study examined disseminated intravascular coagulation (DIC) scores on day 1 and day 3 in sepsis patients and their association with mortality. The incidence of overt DIC was 27.9% on day 1 and 30.1% on day 3. While day 1 and 3 DIC scores were not associated with mortality, the change in DIC score between days was significantly associated with mortality. Patients with pneumonia had lower DIC on day 1 but higher mortality than other sepsis patients. Day 3 DIC scores predicted mortality more accurately than day 1 scores, especially for non-pneumonia sepsis patients.
1. The document provides guidelines from the Infectious Diseases Society of America (IDSA) for using antimicrobial agents in neutropenic patients with cancer.
2. It recommends assessing patient risk level, performing diagnostic tests and cultures, providing appropriate empiric antibiotic therapy based on risk, modifying treatment based on clinical response, considering antifungal therapy for persistent fever, and using prophylaxis in high-risk patients.
3. The guidelines stratify patients as high-risk or low-risk based on factors like anticipated neutropenia duration and comorbidities. This determines treatment venue and duration. Immediate broad-spectrum antibiotics are recommended for high-risk patients.
This document provides guidelines from the Infectious Diseases Society of America (IDSA) for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Some key points:
1. It recommends risk assessment of patients to determine high vs low risk, with high risk patients requiring hospitalization and IV antibiotics.
2. It provides guidelines on initial assessment tests and cultures, as well as recommendations for empirical antibiotic therapy depending on risk level and specific infections of concern.
3. It addresses modifications to treatment based on clinical and microbiological data, duration of therapy, and use of antibiotic and antifungal prophylaxis.
The International Study Group (ISG) criteria and International Criteria for Behcet's Disease (ICBD) are the two main sets of criteria used to diagnose Behcet's Disease. The ISG criteria were developed in 1990 based on data from 7 countries but had low sensitivity in validation studies. The ICBD criteria were developed in 2010 based on data from 27 countries. When evaluated on 3294 patients with Behcet's Disease and 2581 controls from 2000-2016, the ICBD criteria had higher sensitivity (97.4% vs 66.7%), specificity (97.5% vs 99.7%), and accuracy (97.4% vs 81.3%) compared to the ISG criteria
The document discusses several key points:
1) It questions the common belief that childhood exposure to measles provides immunity and that avoiding it threatens health.
2) It suggests that genetically modified foods and agricultural chemicals may promote disease more than genetics.
3) It warns that mandatory vaccinations could require Americans to accept poor and chronic health. Overall, the document casts doubt on mainstream views of health, immunity, and the role of vaccines and industrialized foods.
Multidrugresistant tuberculosis
Among the most menacing forms of MDR is multidrug
resistant tuberculosis (MDR-TB). WHO estimates that
were about 450,000 new cases and 170,000 deaths from
MDR-TB in 2012. The number of cases reported to
WHO rose by an alarming 35% between 2011 and 2012,
although this probably mostly reflects increased recognition
and reporting. Over half the new cases were in India,
China or the Russian Federation.3
This issue of Homeopathy features a paper by Dr Kusum
Chand and colleagues reporting a randomized, double blind,
placebo-controlled clinical trial of individualized homeopathic
treatment or placebo in addition to standard antituberculous
chemotherapy as specified by the Indian Revised
National Tuberculosis Control Program, for MDR-TB
This document provides guidelines from the Infectious Diseases Society of America for the use of antimicrobial agents in neutropenic patients with cancer. Key points include:
1) Patients should be assessed for risk of infection and categorized as high or low risk to guide treatment approach. High risk patients require hospitalization and IV antibiotics.
2) Initial evaluation should include blood cultures and tests to assess organ function. Imaging is indicated if respiratory symptoms are present.
3) High risk patients require broad-spectrum IV antibiotics targeting both gram-positive and gram-negative bacteria. Antifungal therapy or investigation should be considered if fever persists after 4-7 days of antibiotics.
4) Treatment duration depends on infection status and marrow
Similar to Drug reaction with eosinophila and systemic symptoms (20)
- Cat and dog allergens such as Fel d 1 and Can f 1 are major allergens found in fur, dander, and saliva that can become airborne and cause sensitization in a large percentage of allergic individuals.
- Lipocalins make up many mammalian allergens and show cross-reactivity between species due to structural similarities, explaining co-sensitizations between cats, dogs, horses, and other animals.
- Higher levels of IgE antibodies to specific dog lipocalins are associated with more severe asthma in children with dog allergy.
1) DRESS syndrome is a severe cutaneous drug reaction characterized by fever, lymphadenopathy, hematologic abnormalities, multisystem involvement, and viral reactivation. It has a delayed onset of 2-3 weeks after starting the culprit drug.
2) The skin manifestations are typically a polymorphous maculopapular eruption and facial edema. Systemic involvement can include the liver, kidneys, lungs and other organs.
3) Diagnosis is based on clinical criteria including the RegiSCAR scoring system which evaluates morphology, timing of onset, organ involvement, hematologic abnormalities and viral reactivation.
Wheat is one of the most important global food sources and wheat allergy prevalence varies from 0.4-4% depending on age and region. Several wheat proteins have been identified as major allergens, including omega-5-gliadin, alpha-amylase inhibitors, and glutenins. Studies have found that serum testing for IgE antibodies to specific wheat allergens, such as omega-5-gliadin, glutenins, and alpha-amylase inhibitors, can help diagnose wheat allergy and distinguish between mild and severe cases. Sensitization to different wheat allergens is associated with wheat-dependent exercise-induced anaphylaxis versus occupational baker's asthma. Proper diagnosis and
Major indoor allergens include dust mites, domestic animals like cats and dogs, insects like cockroaches, mice, and fungi. Dust mites thrive in warm, humid environments like mattresses, bedding, and upholstered furniture, where they feed on human skin scales and excrete allergenic fecal particles. Cat allergens like Fel d 1 accumulate in fur and can become airborne, causing worse asthma outcomes in sensitized individuals. Minimizing exposure involves removing carpets, frequent washing of bedding, humidity control, HEPA filtration and ventilation.
This document provides information on Hymenoptera, focusing on the families Apidae and Vespidae. It discusses the epidemiology and prevalence of insect venom allergy. It also covers the taxonomy, venom composition, and clinical manifestations of common stinging insects like honeybees, hornets, wasps and yellow jackets. Key allergens are identified for different species.
- NSAIDs hypersensitivity can present with distinct clinical phenotypes based on organ system involvement and timing of symptoms. It is estimated that less than 20% of reported adverse reactions to NSAIDs are true hypersensitivities.
- AERD/NERD involves eosinophilic rhinosinusitis, asthma, and nasal polyps. Exposure to aspirin or other NSAIDs exacerbates bronchospasms and rhinitis. Management involves lifelong avoidance of culprit and cross-reacting NSAIDs.
- Various phenotypes are described beyond the EAACI classification, including blended reactions involving multiple organs, food-dependent NSAID-induced anaphylaxis, and NSAID-selective immediate reactions. Proper diagnosis relies
The document discusses food immunotherapy for treating food allergies. It provides definitions and outlines immune mechanisms and efficacy evidence from studies on peanut, cow's milk, egg, and wheat oral immunotherapy (OIT). Peanut OIT studies showed 67-78% of children achieved desensitization and 21-46% achieved sustained unresponsiveness. Cow's milk and egg OIT also demonstrated desensitization in 50-75% of children. Wheat OIT studies found 52-69% achieved desensitization. OIT was effective at increasing tolerance but also increased rates of adverse events during treatment.
This document summarizes X-linked agammaglobulinemia (XLA), an inherited primary immunodeficiency caused by mutations in the Bruton's tyrosine kinase (Btk) gene. XLA is characterized by absent B cells and low immunoglobulin levels, leading to recurrent bacterial infections starting in infancy. Management involves immunoglobulin replacement and antibiotic therapy. With treatment, life expectancy has improved dramatically though complications can include lung disease. The document also briefly discusses other forms of agammaglobulinemia caused by defects in genes important for early B cell development.
This document discusses histamine and anti-histamines. It provides information on:
1. The structure and function of histamine and its receptors in immune response regulation. Histamine plays a role in processes like antigen presentation and influencing T and B cell responses.
2. The classification and structures of different types of anti-histamines, including first and second generation anti-histamines from different chemical classes.
3. Some anti-histamines have the potential to cause hypersensitivity in rare cases, even those from different chemical classes with no structural similarity.
The document discusses beta-lactam allergy, including penicillin and cephalosporin allergies. It covers the epidemiology, classifications, structures, mechanisms, and investigations of beta-lactam allergies. Specifically, it notes that penicillin is the most commonly reported antibiotic allergy. It describes the hapten concept of small molecules like beta-lactams binding covalently to proteins to form antigen complexes. Skin testing and in vitro tests are used to investigate immediate IgE-mediated allergies, while patch testing is used for delayed reactions.
This document provides an overview of intravenous immunoglobulin (IVIG) therapy. It discusses the structure and classes of immunoglobulins, mechanisms of action including neutralization, opsonization, and modulation of immune cells. It also covers the manufacturing process, pharmacokinetics, indications for use in primary immunodeficiencies and autoimmune diseases, dosing, administration, and adverse effects. The differences between IVIG products are also reviewed.
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In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
3. Historical Background
Year Event
1930 phenytoin first became available observed in patients treated
with anticonvulsants .
1950 reported a case of fever, hepatitis, and exfoliative dermatitis
by Chaiken et al .(Dilantin Hypersensitivity )
1959 described this cutaneous drug reaction as pseudolymphoma
by Saltzstein et al .
hypersensitivity syndrome and mononucleosis-like syndrome
1996 Proposed the term DRESS by Bocquet et al .
Zain Husain, MD,a Bobby Y. Reddy, MD,b and Robert A. Schwartz, MD, MPH, FRCP (Edin)c Washington, DC;
Boston, Massachusetts; and Newark, New Jersey J Am Acad Dermatol 2013;68:693.e1-14.
4.
5. Historical Background
Year Event
1930 phenytoin first became available observed in patients treated
with anticonvulsants .
1950 reported a case of fever, hepatitis, and exfoliative dermatitis
by Chaiken et al .(Dilantin Hypersensitivity )
1959 described this cutaneous drug reaction as pseudolymphoma
by Saltzstein et al .
hypersensitivity syndrome and mononucleosis-like syndrome
1996 Proposed the term DRESS by Bocquet et al .
Zain Husain, MD,a Bobby Y. Reddy, MD,b and Robert A. Schwartz, MD, MPH, FRCP (Edin)c Washington, DC;
Boston, Massachusetts; and Newark, New Jersey J Am Acad Dermatol 2013;68:693.e1-14.
6. The lymphadenopathy is usually associated with the more common
manifestations of drug reactions, such as esoinophilia, fever, blood
dyscrasias, and skin disorders .
Histologically ,characteristically, there is hyperplasia of the reticulum cells
and infiltration with eosinophils .
Histologically, in the drug reaction there is not the uniform picture of
mature lymphocytes ,ReedSternberg cells are never seen, and the nodes
in the drug reaction are usually discrete rather than matted. There is also
less fibrosis in the drug reaction
CANCER January-February 1959
7. Historical Background
Year Event
1930 phenytoin first became available observed in patients treated
with anticonvulsants .
1950 reported a case of fever, hepatitis, and exfoliative dermatitis
by Chaiken et al .(Dilantin Hypersensitivity )
1959 described this cutaneous drug reaction as pseudolymphoma
by Saltzstein et al .
hypersensitivity syndrome and mononucleosis-like syndrome
1996 Proposed the term DRESS by Bocquet et al .
Zain Husain, MD,a Bobby Y. Reddy, MD,b and Robert A. Schwartz, MD, MPH, FRCP (Edin)c Washington, DC;
Boston, Massachusetts; and Newark, New Jersey J Am Acad Dermatol 2013;68:693.e1-14.
8. DRESS
by Bocquet, H., Bagot, M., Roujeau, J.C.
Department of Dermatology, Universite Paris XII, Hopital Henri Mondor,France
two different patterns:
(1) hypersensitivity syndrome which begins acutely in the first 2 months
after the initiation of the drug and associates fever, a severe skin disease
with characteristic infiltrated papules and facial edema or an exfoliative
dermatitis, lymphadenopathy, hematologic abnormalities
(hypereosinophilia, and atypical lymphocytes) and organ involvement
such as hepatitis, carditis, interstitial nephritis, or interstial pneumonitis.
(2) drug-induced pseudolymphoma which has a more insidious beginning
with nodules and infiltrated plaques appearing several weeks after the
beginning of the drug without constitutional symptoms..
Seminars in Cutaneous Medicine and Surgery Volume 15, Issue 4, 1996, Pages 250-257
9. ETIOLOGY
• severe hypersensitivity to a medication and its reactive drug
metabolites , which may be associated with enzymatic
defects in drug metabolism .
• Immunosuppression especially when accompanied by a
primary or reactivation human herpesvirus-6
(HHV-6) infection
Zain Husain, MD,a Bobby Y. Reddy, MD,b and Robert A. Schwartz, MD , J Am Acad Dermatol
2013;68:693.e1-14.
10. Zain Husain, MD,a Bobby Y. Reddy, MD,b and Robert A. Schwartz, MD , J Am Acad Dermatol 2013;68:69
11. ETIOLOGY
• severe hypersensitivity to a medication and its reactive drug
metabolites , which may be associated with enzymatic
defects in drug metabolism .
• Immunosuppression especially when accompanied by a
primary or reactivation human herpesvirus-6
(HHV-6) infection
Zain Husain, MD,a Bobby Y. Reddy, MD,b and Robert A. Schwartz, MD , J Am Acad Dermatol
2013;68:693.e1-14.
14. Human Herpesvirus 6 Infection as a Risk Factor for the Development of Severe Drug-Induced Hypersensitivity Syndrome, Arch Dermatol. 1998;134(9):1108-1112.
.
Clinical course of a patient with a severe drug-induced
hypersensitivity syndrome in relation to antibody titers against
various viruses
26. Viral Reactivation
-
• Direct effect of drugs or metabolites on viral reactivation
• In vitro
- early stage of DRESS syndrome, or DiHS, the number of Treg cells
expands, even as a reduced number of B cells and hypogammaglobulinemia
- pro-inflammatory cytokines and chemokines, such as
TNF-α, IFN-γ, IL-1, IL-2, IL-6, are seen in lower levels in the early stage of the
disease in patients with HHV-6 reactivation than in those without HHV-6
reactivation,
with the exception of one chemokine, interferon γ-induced protein (IP)-10
Yung-Tsu Cho, Che-Wen Yang and Chia-Yu Chu , Int. J. Mol. Sci. 2017, 18,
31. A decrease in immunoglobulin levels and
B-cell counts can be associated with HHV-6
reactivation and the subsequent onset of AHS.
These immunological alterations might be a
useful predictor of the development of AHS.
Yoko Kano, MD; Miyuki Inaoka, MD; Tetsuo Shiohara, MD ,Arch Dermatol. 2004;140:183
36. Skin lesion
Present in 73-100% .
Facial edema found in
76% of patients, is the
hallmark feature of disease
Yung-Tsu Cho, Che-Wen Yang and Chia-Yu Chu , Int. J. Mol. Sci. 2017, 18,
39. Internal organ involvement
• Both hematological abnormalities and impairment of solid organs.
• Hematological changes , eosinophilia is the most common (66-95%)
,atypical lymphocyte (27-67%)
• Lymphadenopathy (54%)
• Decreased number of B lymphocytes with hypoglobulinemia.
Yung-Tsu Cho, Che-Wen Yang and Chia-Yu Chu , Int. J. Mol. Sci. 2017, 18, 1
40. Internal organ involvement
Liver injury found in 75-94% of patients: cholestatic type 44%
, mixed type 33% , hepatocellular type 23%
Renal involvement (12-40%) :allopurinol is the most notorious
one .
Lung involvement : interstitial pneumonitis ,pleuritis,acute
respiratory distress
Cardiac involvement ( 4-27% ) :hypersensitivity myocarditis,
acute necrotizing eosinophilic myocarditis .
Neurologic involvement (menigitis,encephalitis )
Yung-Tsu Cho, Che-Wen Yang and Chia-Yu Chu , Int. J. Mol. Sci. 2017, 18,
1243
49. Zain Husain, MD,a Bobby Y. Reddy, MD,b and Robert A. Schwartz, MD , J Am Acad Dermatol 2013;68:693.e1-1
50.
51.
52. Clinical testing
• patch testing. Its negative predictive values (NPVs) and positive
predictive values (PPVs) are unknown. The PPV of patch testing
under optimal conditions was as high as 80% to 90% for certain drugs,
but only around 10% to 20% for other medications.
Santiago et al reported an overall 32.1% positive patch test result
in patients with DRESS syndrome, with 51.5% reactivity among all
antiepileptics and 72.2% with carbamazepine alone. This contrasts with
the 0% reactivity seen with allopurinol as the causative
agent
As a result, a positive patch test is a highly reliable indicator of an inflammatory
cutaneous hypersensitivity reaction, while a negative test does not exclude it.
J Am Acad Dermatol 2013;68:693.e1-14.
53. Clinical testing
• LTT technique has a general sensitivity in the range of 60% to
70% and an overall specificity of at least 85%
• it is recommended to perform LTT 5 to 8 weeks after the onset of DRESS
syndrome
• limitations of LTT include its cumbersome nature, the need for significant
experience
with cellular techniques, expensive equipment, and
the reliance upon an interpreter with a strong background in pharmacology
and immunology
because of its limited sensitivity, a negative LTT cannot exclude drug
hypersensitivity
J Am Acad Dermatol 2013;68:693.e1-14.
59. Treatment
Tetsuo Shiohara, Yoko Kano, Kazuhisa Hirahara & Yumi Aoyama, Expert Opinion on Drug Metabolism & Toxicology, 13:7, 701-704
60. - should not be given empiric antibiotics or anti-inflammatory drugs during the
acute stages of DRESS syndrome
- minimum dose of 1.0 mg/kg/day of prednisone or equivalent. Gradual taper over 3 to
6 months after clinical and laboratory stabilization is recommended to avoid relapse
- Can be treated with intravenous methylprednisolone. A course of pulsed
methylprednisolone, 30 mg/kg intravenously for 3 days
- Immunosuppression from steroid therapy may promote the reactivation of viruses,
such as HHV-6 or CMV
61. Alternative steroid-sparing therapies :
• nevirapine-induced DRESS syndrome successfully treated with IVIG (1 g/kg
for 2 days).
• Did not recommend the use of IVIG monotherapy in the treatment of
DRESS syndrome.
• IVIG is thought to be effective in DRESS syndrome therapy because it
replenishes the low immunoglobulin levels in the patient’s blood, supports
immune protection against HHV-6, and has antiinflammatory properties
• Plasmapharesis and immunosuppressive drugs,
such as cyclophosphamide, cyclosporine, interferons,
muromonab-CD3, mycophenolate mofetil, and rituximab, may also be
potential therapies
J Am Acad Dermatol 2013;68:693.e1-14.
62. A consensus group of the French Society of Dermatology
has published recommendations
1) withdrawal of the culprit drug. Absence of signs of severity
2) systemic corticosteroids equivalent to 1 mg/kg/day of prednisone is
warranted. If life-threatening signs can be treated with steroids
and IVIG at not be administered without associated steroids.
3) In cases with signs of severity with confirmation of major viral
reactivation, antiviral medications such as ganciclovir can be given
in addition to steroids and /or IVIG. a dose of 2 g/kg over 5 days.
The IVIG should
J Am Acad Dermatol 2013;68:693.e1-14.
67. Take Home Message
DRESS syndrome is a potentially fatal cutaneous drug reaction with a
10% mortality rate.
Diagnosis using clinical criteria, laboratory values,histopathology, and
diagnostic testing is imperative.
The offending drug should be immediately discontinued and the
patient given supportive care in an inpatient setting to minimize
complications.
Severe cases of DRESS syndrome require systemic corticosteroids or
other immunotherapeutic treatments