CASE PRESENTATION

NAME :- VELLAMA
CITY :- BELGAU
DATE :- 20/07/2022

Date of admission :- 20/07/2022

Because of ST-elevation myocardial infarction

COMPLAIN
o Fever
o Rash (08/16/20)
o Eosinophilia
o concern for drug-induced hypersensitivity

K/C/O
o DM 1
o Hyperlipidaemia

TAKEN MEDICATIONS
1. Vancomycin
2. Aspirin
3. Captopril

SYNDROMES
 o Erythema Multiforme (EM)
o Toxic Epidermal Necrolysis (TEN)
o Hypersensitivity Syndrome/Drug Rash
with Eosinophilia and Systemic Symptoms (DRESS)

Main differential diagnoses

o Erythema Multiforme Major
o Acute generalized erythematous pustulosis
o Intermediate burns
o Lupus erythematosus
o Exfoliative dermatitis DRESS/HSS

DRESS SYNDROME
Clinical sings
Typical onset of eruption 2-6 weeks
Typical duration of eruption Several weeks
Fever +++
Infiltrated papules +++
Facial edema +++
Pustules +
Blisters +
Laboratory values
Hepatitis +++
Neutrophil count +
Eosinophil count +++
Atypical lymphocytes ++

Pathophysiology
o Potentially life-threatening severe skin eruption, with fever, hematologic
abnormalities, and internal organ involvement.
o Extremely heterogeneous
Treatment
o Drug discontinuation
o No RCT’s !
o Steroids
Only if clinical worsening after discontinuation of offending drug
o (Cont.)
Cyclosporine
One in which a five day couse of cyclosporine resulted in resolution of symptoms, in
vancomycin-induced DRESS refractory to steroids
Another in which cyclosporine 4mg/kg/day was added after 1 yr on prednisone and
persistent symptoms (alopecia, erythroderma, eosinophilic pneumonia)
N-acetylcysteine
IVIG
Interferon alpha
Desensitization