Published online Mar 26, 2019. doi: 10.12998/wjcc.v7.i6.705
Peer-review started: September 6, 2018
First decision: October 11, 2018
Revised: February 5, 2019
Accepted: February 26, 2019
Article in press: February 26, 2019
Published online: March 26, 2019
Processing time: 202 Days and 22.1 Hours
First described in 1996, the drug reaction, eosinophilia, and systemic symptoms syndrome (DReSS) is considered, along with Stevens-Johnson syndrome and toxic epidermal necrolysis, a severe cutaneous drug reaction. It is characterized by the presence of a maculopapular erythematous skin eruption, fever, lymphadenopathy, influenza-like symptoms, eosinophilia, and visceral involvement such as hepatitis, pneumonitis, myocarditis, pericarditis, nephritis, and colitis. The prognosis of patients with DReSS is related to the severity of visceral involvement. The mortality ranges from approximately 5% to 10%, and death is mainly due to liver failure, which is also the organ most commonly involved in this syndrome. Although it was previously hypothesized in 1994, DReSS syndrome can lead to reactivation of one or more human herpesvirus family members. Now being included as diagnostic criteria in a proposed diagnostic score system, this reactivation can be detected up to 2-3 wk after DReSS syndrome onset. Other causes of mortality in DReSS syndrome include myocardial or pulmonary lesions and hemophagocytosis. We reviewed the literature of previously reported case-series of DReSS and liver involvement, highlighting the pattern of liver damage, the treatment used, and the outcome.
Core tip: Drug reaction, eosinophilia, and systemic symptoms syndrome (DReSS) is considered a severe cutaneous drug reaction. It can present with a broad spectrum of clinical manifestations making its diagnosis challenging. Factors associated with a poor prognosis include delayed diagnosis, viral reactivation, the presence of systemic inflammatory response syndrome, and severe organ involvement. Liver injury, presented in more than half of DReSS patients, ranges from mild transaminasemia to acute liver failure and is one of the most common causes of death in these patients. Prompt withdrawal of the culprit agent and a multidisciplinary approach in patients with internal organ affection are of utmost importance.