Dermatology

Question 1

What is DRESS syndrome?

Answer 1

A severe reaction to a medication causing:
- high fever
- morbilliform eruption
- haem abnormalities
- lymphadenopathy
- inflammation of organs

Question 2

What drugs are most implicated in DRESS?

Answer 2

Anticonvulsants - phenytoin, carbamazepine, phenobarbitol
Allopurinol
Olanzipine
Sulphonamide antibiotics

Question 3

When does DRESS develop in relation to starting a drug?

Answer 3

Beta-lactams - within 2 weeks
Others - 2-8 weeks

Question 4

What are the clinical features of DRESS?

Answer 4

High fever
Widespread skin rash of varying morphology
Facial swelling
Mucosal involvement
Enlarged LNs
Raised or low WCC
Eosinophilia
Atypical lymphocytes
Thrombocytopenia
Anaemia
HLH
Hepatitis / liver enlargement / derranged LFTs
Mild interstitial nephritis
Myocarditis/ pericarditis
Meningitis / encehpalitis / seizures / coma / palsies
Gastroenteritis / pancreatitits / bleeding / colitis
Thyroiditis
Myositis
Uveitis

Question 5

What do pts with DRESS syndrome die from?

Answer 5

Acute liver failure
MOF
Fulminant myocarditis
Haemophagocytosis

Question 6

What are the diagnositc criteria for DRESS?

Answer 6

3 of the following:
- hospitalisation
- reaction suspected to be drug
- acute skin rash
- T > 38
- Enlarged LNs at 2 sites
- Involvement of at least 1 internal organ
- Blood count abnormalities

Question 7

How is DRESS treated?

Answer 7

Stop drug
Steroids
Ciclosporin is an alternative
+/- IVIG, plasma exchange, rituximab, cyclophophamide