Ann Hepatobiliary Pancreat Surg.  2021 Nov;25(4):551-555. 10.14701/ahbps.2021.25.4.551.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in liver transplantation

• Cho A
• Lee JM
• Hong K
• Han ES
• Hong SK
• Choi Y
• Yi NJ
• Lee KW
• Suh KS

• KMID: 2523062
• DOI: http://doi.org/10.14701/ahbps.2021.25.4.551

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare delayed-type hypersensitivity reaction that causes skin abnormalities and mucosal involvement of the entire body. This is a case report of DRESS occurring in a liver transplantation recipient after taking drugs. A 57-year-old female patient with hepatocellular carcinoma underwent living donor liver transplantation in April 2019. She had no previous medical histories relevant to allergic diseases. There were no adverse events during hospitalization. She was admitted to evaluate and treat a headache occurring at one month after transplantation. However, she suffered from adverse drug reactions after taking anticonvulsants, showing skin rash, itching sense, and fever with eosinophilia. Piperacillin/Tazoperan was administered for ten days as an empirical antibiotic. Skin biopsy was performed on postoperative day 106 for erythematous maculopapular rash in the arms, legs, and torso. Her symptoms improved after discontinuation of the suspected medication with conservative skin treatment and high-dose steroid treatment. This case suggests that suspicion of drug history is essential for early diagnosis and management of DRESS.

Keyword

Drug hypersensitivity; Eosinophilia; Liver transplantation; Severe cutaneous adverse reaction

Figure

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  Fig. 1 Relationships of the disease progression course with eosinophil count and medication history. LDLT, living donor liver transplantation; POD, postoperative day; GVHD, graft-versus-host disease; CMV, cytomegalovirus; IVIG, intravenous immunoglobulin.

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  Fig. 2 (A) Skin biopsy showing superficial perivascular lymphocytic infiltration, suggestive of acute graft-versus-host disease (H&E, ×400). (B) Liver biopsy showing acute hepatitis and reactive hemophagocytosis due to drug/toxin-induced liver injury (Masson’s Trichrome stain, ×800).

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  Fig. 3 (A) Skin lesion of torso including neck. (B) Right forearm. (C) Onycholysis of nails. (D) Ulcerative lesions on total palate. (E) Lip and tongue. (F) Vulva and perianal area.

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