Drug reaction with eosinophilia and systemic symptoms: Analysis of cutaneous phenotype as a prognosis factor

• Published in: Revue française d'allergologie (2009) 2024-11, Vol.64 (6), p.104161, Article 104161
• Main Authors: Sqalli-Houssini, G., Douhi, Z., Soughi, M., Elloudi, S., Baybay, H., Moukafih, B., Omari, M., El Rhazi, K., Mernissi, F.Z.
• Format: Article
• Language: English
• Subjects: Allopurinol; DRESS; Drug; Erythroderma; Exanthem; Exanthème; Médicament; Rash; Toxidermia; Toxidermie; Érythrodermie
• ISSN: 1877-0320
• DOI: 10.1016/j.reval.2024.104161

The DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is a severe and potentially fatal toxidermia due to various visceral involvements. Identifying factors predisposing to serious complications is essential for clinical and therapeutic management. This study aims to analyze the cutaneous presentation of DRESS and its role as a prognostic factor. This is a retrospective, descriptive, and analytical study conducted over nine years at the dermatology department in Fes, including all hospitalized DRESS cases. The maculopapular rash was the most frequent phenotype (49.3%), followed by erythroderma, morbilliform exanthem, and polymorphous erythema-like rash. In all, 52.8% of patients had renal involvement and 45.8% had hepatic involvement, while 81.9% exhibited hypereosinophilia. The maculopapular rash and erythroderma were more associated with internal organ involvement, although no significant statistical correlation could be demonstrated. Allopurinol was the most implicated drug in 51.4% of the cases. No correlation was found between the type of medication and the cutaneous presentation. In all, 8.3% of the patients died, primarily those with erythroderma (15.8%). Our study demonstrated that maculopapular rash and erythroderma are the most common presentations and are most associated with internal organ complications, with a more unfavorable prognosis for erythrodermic cases. Le syndrome DRESS (drug reaction with eosinophilia and systemic symptoms) est une toxidermie grave et potentiellement mortelle due à diverses atteintes viscérales. Identifier les facteurs prédisposant à des complications graves est essentiel pour la gestion clinique et thérapeutique. Cette étude vise à analyser le tableau cutané du DRESS et son rôle comme facteur pronostique. Il s’agit d’une étude rétrospective, descriptive et analytique sur neuf ans, menée au service de dermatologie de Fès, incluant tous les cas de DRESS hospitalisés. Le rash maculopapuleux était le phénotype le plus fréquent (49,3 %), suivie par l’érythrodermie, l’exanthème morbilliforme et l’érythème polymorphe like. Au total, 52,8 % des patients présentaient une atteinte rénale et 45,8 % une atteinte hépatique, tandis que 81,9 % avaient une hyperéosinophilie. Le rash maculopapuleux et l’érythrodermie étaient plus associés aux atteintes d’organes internes, sans pouvoir démontrer une corrélation statistique significative. L’allopurinol était le médicament le plus incriminé dans 51,4 % des cas. Auc