Korean J Hepatol.  2012 Mar;18(1):84-88. 10.3350/kjhep.2012.18.1.84.

Drug rash with eosinophilia and systemic symptoms syndrome following cholestatic hepatitis A: a case report

• An J
• Lee JH
• Lee H
• Yu E
• Lee DB
• Shim JH
• Yoon S
• Lee Y
• Park S
• Lee HC

• KMID: 1372655
• DOI: http://doi.org/10.3350/kjhep.2012.18.1.84

Abstract

Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.

Keyword

Hepatitis A; Drug hypersensitivity; DRESS syndrome; Acute kidney injury

MeSH Terms

Acute Kidney Injury/diagnosis
Anti-Bacterial Agents/*adverse effects/therapeutic use
Cefotaxime/adverse effects/therapeutic use
Cholestasis/complications/*diagnosis
Cytomegalovirus/genetics
Cytomegalovirus Infections/drug therapy/virology
DNA, Viral/analysis
Eosinophilia/etiology
Exanthema/*chemically induced/pathology
Ganciclovir/therapeutic use
Hepatitis A/complications/*diagnosis/drug therapy
Humans
Hydrocortisone/therapeutic use
Immunoglobulins/therapeutic use
Male
Syndrome
Young Adult