Korean J Asthma Allergy Clin Immunol.  2006 Mar;26(1):89-93.

A Case of Sulfasalazine Induced DRESS Syndrome (Drug Rashs with Eosinophilia and Systemic Symptoms)

Abstract

DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) is a rather distinct severe adverse drug reaction characterized by skin rash, fever, lymph node enlargement, and single or multiple organ involvements, which starts within 8 weeks after the initiation of the drug therapy. The aromatic anticonvulsants and sulfonamides are the most common causes. The mortality rate is at least 10%. The pathogenesis is not fully understood and may be multifactorial. However, few cases of DRESS were reported, and sulfasalazine induced DRESS was not reported in Korea. We experienced a case of a 23-year-old woman who had been on sulfasalazine for 5 weeks to treat rheumatoid arthritis and then de veloped fever, skin rash, facial edema. She had leukocytosis (28,200/mm(3)) with hypereosinophilia (4,730/mm(3)), hepatitis and moderate cholestasis (alkaline phosphatase, 241 IU/L and gamma-GT, 143 IU/L). The patients did not have anti- human herpes simplex virus IgM and varicella zoster IgM antibodies. Ultrasonography showed enhanced echogensity in liver. She was treated with high dose of steroid for 4 days and with tapered doses for 1 months, and Nacetylcystein was administered intravenousely for 3 days. The patient was recovered completely.

MeSH Terms

Antibodies
Anticonvulsants
Arthritis, Rheumatoid
Chickenpox
Cholestasis
Drug Hypersensitivity Syndrome*
Drug Therapy
Drug-Related Side Effects and Adverse Reactions
Edema
Eosinophilia*
Exanthema*
Female
Fever
Hepatitis
Herpes Zoster
Humans
Immunoglobulin M
Korea
Leukocytosis
Liver
Lymph Nodes
Mortality
Simplexvirus
Sulfasalazine*
Sulfonamides
Ultrasonography
Young Adult
Antibodies
Anticonvulsants
Immunoglobulin M
Sulfasalazine
Sulfonamides