DRESS syndrome in a patient on sulfasalazine for rheumatoid arthritis.

Joint Bone Spine

Rheumatology Department, CHU Jean Minjoz Teaching Hospital, Boulevard Fleming, Besançon, cedex 25030, France.

Published: January 2005

AI Article Synopsis

  • DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) is a severe drug-induced hypersensitivity syndrome that can resemble malignant lymphoma and was diagnosed in a 63-year-old woman after symptoms developed while taking sulfasalazine for rheumatoid arthritis.
  • Blood tests revealed high eosinophil levels and inflammation, while an assay indicated recent infection with human herpesvirus 6 (HHV6), which may play a role in the development of DRESS syndrome.
  • With a mortality rate of around 10%, it's crucial for healthcare providers to maintain a high suspicion for DRESS in patients on certain medications and to test for HHV6 in suspected cases.

Article Abstract

DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) is a drug-induced hypersensitivity syndrome that can mimic malignant lymphoma. We report a case in a 63-year-old woman who had been on sulfasalazine for 2 months to treat rheumatoid arthritis. She was admitted a few days after onset of a flu-like syndrome with a pruriginous maculopapular erythema initially involving the face, trunk, and proximal limbs; a fever of 41 degrees C; and enlargement of the liver, spleen, and several peripheral lymph nodes. Blood tests showed marked eosinophilia (9300/mm3), lymphocytosis, hyperbasophilic cells, and severe inflammation. DRESS syndrome was diagnosed. An indirect immunofluorescence assay for human herpesvirus 6 (HHV6) was positive, supporting recent HHV6 infection. Primary HHV6 infection and HHV6 reactivation have been incriminated in the genesis of DRESS syndrome. DRESS syndrome continues to carry a high mortality rate of about 10%. Drugs previously reported to cause DRESS syndrome include sulfasalazine, hydantoin, d-penicillamine, allopurinol, hydrochlorothiazide, and cyclosporine. A high index of suspicion for DRESS syndrome should be maintained in patients receiving these drugs. Serological tests for HHV6 should be performed routinely in patients with suspected DRESS syndrome, although uncertainty persists about the link between HHV6 infection and DRESS syndrome.

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Source
http://dx.doi.org/10.1016/j.jbspin.2004.06.002DOI Listing

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