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Drug reaction with eosinophilia and systemic symptoms (DRESS) : estudo baseado num caso clínico
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Introdução: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) é uma síndrome rara, que corresponde a uma grave reação de hipersensibilidade a medicamentos. É caracterizada pelo aparecimento de lesões exantemáticas polimórficas, febre e disfunção multi-orgânica. O síndrome DRESS é uma entidade particularmente rara nas crianças. Caso clínico: Criança de 31 meses de idade, sexo masculino, com antecedentes de artrite sética, gengivoestomatite viral e rinite alérgica. É trazida ao serviço de urgência por exantema máculo-papular eritematoso pruriginoso, e febre (TT 38ºC), ao 8º dia de amoxicilina e ácido clavulânico. Ao exame objetivo apresentava moderado edema centro-facial, angioedema da língua e murmúrio vesicular rude. Laboratorialmente apresentava linfocitose atípica, elevação das transaminases hepáticas e aumento do ratio proteínas/creatinina na urina. A serologia para o vírus Epstein-Barr foi positiva para Ac. Anti-VCA-IgG e Ac. Anti-EBNA-IgG. As restantes serologias encontravam-se negativas. Conclusão: O DRESS síndrome é uma reação adversa medicamentosa (RAM) grave com características clínicas bem definidas e um complexo mecanismo fisiopatológico. O reconhecimento precoce deste quadro, a suspensão imediata do medicamento suspeito e a implementação de medidas de suporte revelam-se fundamentais no prognóstico e na redução da morbilidade/mortalidade destes pacientes. Neste caso clínico, o diagnóstico baseou-se na história clínica, no risco associado de certos medicamentos e em testes in vivo para a droga suspeita. A biopsia de pele sugestiva de RAM com a presença de eosinófilos e testes de hipersensibilidade não imediata, Patch tests, revelaram-se métodos úteis na confirmação de DRESS induzido por β-lactâmicos.
Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is an uncommon but serious hypersensitivity drug reaction. It is characterized by a polymorphic disseminated eruption with fever and multiple organ dysfunction. DRESS syndrome is a rare clinical condition in children. Case Report: A 31 months-old boy, with a history of septic arthritis, aphthous stomatitis and allergic rhinitis. The patient developed a diffuse and pruritic maculopapular rash, associated with fever (TT 38ºC) after 8 days of amoxicillin/ clavulanate therapy. On the physical examination: centro-facial edema, angioedema of the tongue and rough vesicular breath sound. Laboratory findings revealed atypical lymphocytosis, elevated serum transaminases, and discrete elevation of protein/creatinine ratio on urinalisys. Positive Ac. Anti-VCA-IgG and Ac. Anti- EBNA-IgG for Epstein-Barr vírus. Other serologic studies were negative. Conclusion: DRESS is a severe adverse drug reaction with unique clinical features and complex pathological-mechanisms. Early recognition of these reactions, withdrawal of possible causative drugs and adequate supportive care are mainstays of improving patient prognosis and reduce morbidities/mortality. In this study the diagnosis is based on clinical history, the associated risk of some drugs to trigger DRESS, and the in vivo testing of the suspected drug. Skin biopsy with eosinophils suggests a cutaneous drug reaction and delayed hypersensitivity test, in our case patch tests, were a safe and useful method in confirming the culprit drug in DRESS induced β-lactam.
Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is an uncommon but serious hypersensitivity drug reaction. It is characterized by a polymorphic disseminated eruption with fever and multiple organ dysfunction. DRESS syndrome is a rare clinical condition in children. Case Report: A 31 months-old boy, with a history of septic arthritis, aphthous stomatitis and allergic rhinitis. The patient developed a diffuse and pruritic maculopapular rash, associated with fever (TT 38ºC) after 8 days of amoxicillin/ clavulanate therapy. On the physical examination: centro-facial edema, angioedema of the tongue and rough vesicular breath sound. Laboratory findings revealed atypical lymphocytosis, elevated serum transaminases, and discrete elevation of protein/creatinine ratio on urinalisys. Positive Ac. Anti-VCA-IgG and Ac. Anti- EBNA-IgG for Epstein-Barr vírus. Other serologic studies were negative. Conclusion: DRESS is a severe adverse drug reaction with unique clinical features and complex pathological-mechanisms. Early recognition of these reactions, withdrawal of possible causative drugs and adequate supportive care are mainstays of improving patient prognosis and reduce morbidities/mortality. In this study the diagnosis is based on clinical history, the associated risk of some drugs to trigger DRESS, and the in vivo testing of the suspected drug. Skin biopsy with eosinophils suggests a cutaneous drug reaction and delayed hypersensitivity test, in our case patch tests, were a safe and useful method in confirming the culprit drug in DRESS induced β-lactam.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Síndrome de hipersensibilidade a medicamentos Eosinofilia Reações adversas a medicamentos Pediatria