DRESS syndrome associated with reactivation of viral hepatitis A: A case report with brief communication

• Published in: Revue française d'allergologie (2009) 2024-04, Vol.64
• Main Authors: Almheirat, Y., Benkaraache, M., Elyamani, L., Zerouki, N., Dikhaye, S., Zizi, N.
• Format: Article
• Language: fre
• ISSN: 1877-0320; 1877-0320
• DOI: 10.1016/j.reval.2024.103960

(contexte de la recherche) Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characterized by an extensive skin rash in association with visceral organ involvement, lymphadenopathy, eosinophilia, and atypical lymphocytosis. We report an unusual case of DRESS syndrome associated with reactivation of viral hepatitis A. A 58-year-old female patient with a history of an acute attack of gout was treated with allopurinol 300mg/day. She visited the emergency department because of a febrile generalized rash four days after taking allopurinol. She was apyretic, with generalized scarlatiniform exanthema spreading over the face, neck, trunk, and limbs. She had an adenopathy on the right side of the groin. Biologically she had hyperleukocytosis, with eosinophil predominance, hepatic cytolysis associated with hepatic cholestasis. And acute severe renal failure. C-reactive protein was positive. Hepatitis A virus serology was positive (IgM+, IgG+). Skin biopsy features consistent with drug reaction. The patient was treated with prednisone 0.5mg/kg/day with good clinical biological evolution. DRESS syndrome is a rare drug reaction of the skin. This is a delayed reaction that usually occurs 2–6 weeks after taking a treatment. In our case, the short delay does not exclude imputability, because cases of DRESS with a short delay between 2 and 15 days have also been described. Two main pathogenetic mechanisms are suspected: the first is a drug-specific immune response. The second is reactivation of viruses especially from the Herpesviridae family. During the acute stage of DRESS, the population of regulatory T cells is increased, whereas the number of B cells and plasma levels of immunoglobulins are reduced, which may facilitate viral reactivation. The association of DRESS syndrome with hepatitis A virus documented in our case is rarely described in the literature. DRESS syndrome has recently been considered a viral disease in the majority of cases. We report an unusual association with hepatitis A virus, a viral infection that can predispose to severe drug reaction through acute liver injury.