J Korean Med Sci.  2008 Jun;23(3):521-525. 10.3346/jkms.2008.23.3.521.

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Induced by Celecoxib and Anti-tuberculosis Drugs

• Lee JH
• Park HK
• Heo J
• Kim TO
• Kim GH
• Kang DH
• Song GA
• Cho M
• Kim DS
• Kim HW
• Lee CH

• KMID: 1786894
• DOI: http://doi.org/10.3346/jkms.2008.23.3.521

Abstract

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome reflects a serious hypersensitivity reaction to drugs, characterized by skin rash, fever, lymph node enlargement, and internal organ involvement. So far, numerous drugs such as sulfonamides, phenobarbital, sulfasalazine, carbamazepine, and phenytoin have been reported to cause the DRESS syndrome. We report a case in a 29-yr-old female patient who had been on celecoxib and anti-tuberculosis drugs for one month to treat knee joint pain and pulmonary tuberculosis. Our patient's clinical manifestations included fever, lymphadenopathy, rash, hypereosinophilia, and visceral involvement (hepatitis and pneumonitis). During the corticosteroid administration for DRESS syndrome, swallowing difficulty with profound muscle weakness had developed. Our patient was diagnosed as DRESS syndrome with eosinophilic polymyositis by a histopathologic study. After complete resolution of all symptoms, patch tests were positive for both celecoxib and ethambutol. Although further investigations might be needed to confirm the causality, celecoxib and ethambutol can be added to the list of drugs as having the possibility of DRESS syndrome.

Keyword

Drug Hypersensitivity; Celecoxib; Ethambutol; Myositis; Korea, Female

MeSH Terms

Adult
Anti-Inflammatory Agents, Non-Steroidal/adverse effects
Antitubercular Agents/adverse effects
Arthritis/complications/*drug therapy
Drug Eruptions/*etiology/pathology
Eosinophilia/*chemically induced/pathology
Ethambutol/*adverse effects
Female
Humans
Myositis/chemically induced/pathology
Pyrazoles/*adverse effects
Sulfonamides/*adverse effects
Syndrome
Tuberculosis, Pulmonary/complications/*drug therapy

Figure

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  Fig. 1 Diffuse erythema on the patient's right arm (A) and both legs (B).

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  Fig. 2 Histologic examination shows intraepidermal eosinophil infiltration and spongiosis. Perivascular inflammatory cell cuffing is also noted. Hematoxylin and eosin stain (H&E), ×400.

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  Fig. 3 On histologic examination, myofibers show atrophy and degenerative changes. Interstitial eosinophilic and lymphocytic infiltration is noted. H&E, ×400.

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  Fig. 4 Patch test results to celecoxib and anti-Tb drugs.

Reference

1. Bocquet H, Bagot M, Roujeau JC. Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Semin Cutan Med Surg. 1996. 15:250–257.

2. Sullivan JR, Shear NH. The drug hypersensitivity syndrome: what is the pathogenesis. Arch Dermatol. 2001. 137:357–364.

3. Marques S, Milpied B, Foulc P, Barbarot S, Cassagnau E, Stalder JF. Severe cutaneous drug reactions to celecoxib (Celebrex). Ann Dermatol Venereol. 2003. 130:1051–1055.

4. La Grenade L, Lee L, Weaver J, Bonnel R, Karwoski C, Governale L, Brinker A. Comparison of reporting of Stevens-Johnson syndrome and toxic epidermal necrolysis in association with selective COX-2 inhibitors. Drug Saf. 2005. 28:917–924.

5. Knowles S, Shapiro L, Shear NH. Should celecoxib be contraindicated in patients who are allergic to sulfonamides? Revisiting the meaning of sulfa allergy. Drug Saf. 2001. 24:239–247.

6. Strauss RM, Green ST, Gawkrodger DJ. Rifampicin allergy confirmed by an intradermal test, but with a negative patch test. Contact Dermatitis. 2001. 45:108.

7. Pitt FW. Hook EW, Mandell GL, Gwaltney JM, editors. Tuberculosis, prevention and therapy. Current concepts of infectious disease. 1977. New York: John Wiley & Sons;181–194.

8. Holdiness MR. Adverse cutaneous reactions to antituberculosis drugs. Int J Dermatol. 1985. 24:280–285.

9. Pegram PS Jr, Mountz JD, O'Bar PR. Ethambutol-induced toxic epidermal necrolysis. Arch Intern Med. 1981. 141:1677–1678.

10. Kaufman LD, Kephart GM, Seidman RJ, Buhner D, Qvarfordt I, Nassberger L, Gleich GJ. The spectrum of eosinophilic myositis. Clinical and immunopathogenic studies of three patients, and review of the literature. Arthritis Rheum. 1993. 36:1014–1024.

11. Meng Q, Ying S, Corrigan CJ, Wakelin M, Assoufi B, Mogbel R, Kay AB. Effects of rapamycin, cyclosporine A, and dexamethasone on interleukin 5-induced eosinophil degranulation and prolonged survival. Allergy. 1997. 52:1095–1101.

12. Ahn CM, Moon JH, Moon JG, Lee KM, Lee JH, Hong CS, Park JW. A case of cephalosporin-induced DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome with acute renal failure. J Asthma Allergy Clin Immunol. 2005. 25:69–72.

13. Valencak J, Ortiz-Urda S, Heere-Ress E, Kunstfeld R, Base W. Carbamazepine induced DRESS syndrome with recurrent fever and exanthema. Int J Dermatol. 2004. 43:51–54.

14. Kano Y, Inaoka M, Sakuma K, Shiohara T. Virus reactivation and intravenous immunoglobulin (IVIG) therapy of drug-induced hypersensitivity syndrome. Toxicology. 2005. 209:165–167.

15. Tas S, Simonart T. Management of drug rash with eosinophilia and systemic symptoms (DRESS syndrome): an update. Dermatology. 2003. 206:353–356.

16. Kim CW, Choi GS, Yun CH, Kim DI. Drug hypersensitivity to previously tolerated phenytoin by carbamazepine-induced DRESS syndrome. J Korean Med Sci. 2006. 21:768–772.

17. Lachapelle JM, Maibach HI. Patch testing. Prick testing. A practical guide. 2003. Berlin: Springer.

18. Arellano F, Sacristan JA. Allopurinol hypersensitivity syndrome: a review. Ann Pharmacother. 1993. 27:337–343.