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A Cause of Unpredictable Multiorgan Failure

Majed Eshki, MD; Laurence Allanore, MD; Philippe Musette, MD, PhD; Brigitte Milpied, MD; Anne Grange, MD; Jean-Claude Guillaume, MD; Olivier Chosidow, MD, PhD; Isabelle Guillot, MD; Valérie Paradis, MD; Pascal Joly, MD, PhD; Béatrice Crickx, MD; Sylvie Ranger-Rogez, PhD; Vincent Descamps, MD, PhD

Arch Dermatol. 2009;145(1):67-72.

Background  Factors implicated in the severity of drug reaction with eosinophilia and systemic symptoms (DRESS) have not been identified. We retrospectively describe and analyze severe cases of DRESS defined by history of intensive care unit admission and death due to DRESS.

Observations  Of 15 patients retrospectively recruited in France, 14 were admitted to the intensive care unit and 3 died. The culprit drugs were already known to cause or trigger DRESS: allopurinol, minocycline hydrochloride, anticonvulsants, sulfonamides, and antibiotics. Visceral involvement with severe manifestations responsible for intensive care unit admission or death was variable and often multiple (pneumonitis, hepatitis, renal failure, encephalitis, hemophagocytosis, cardiac failure, and pancytopenia) and resulted in multiorgan failure in 11 patients. These severe complications sometimes developed late in DRESS. Human herpesvirus 6 infection was demonstrated in 6 of 7 patients. In addition, human herpesvirus 6 infection was demonstrated in involved viscera in 2 patients.

Conclusions  Severe DRESS is rare. Some specificities of visceral involvement were associated with allopurinol and minocycline. However, visceral involvement comprising multiorgan failure seemed to be unpredictable. Better knowledge of DRESS is necessary to propose specific and prompt treatment. Early demonstration of human herpesvirus 6 reactivation could be considered a prognostic factor for identifying patients at higher risk and, hence, needs to be evaluated.

Author Affiliations: Departments of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique des Hôpitaux de Paris, Paris (Drs Eshki, Crickx, and Descamps), Henri Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Créteil (Dr Allanore), Charles Nicolle Hospital, Rouen (Drs Musette and Joly), Saint André Hospital, Bordeaux (Dr Milpied), Robert Debré Hospital, Reims (Dr Grange), Hôpitaux Civils de Colmar, Colmar (Dr Guillaume), Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris (Dr Chosidow), and Pierre Benite Hospital, Lyon (Dr Guillot); Department of Anatomopathology, Beaujon Hospital, Assistance Publique des Hôpitaux de Paris, Paris (Dr Paradis); and Department of Virology, Dupuytren Hospital, Limoges (Dr Ranger-Rogez), France.

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