Martinez-Cabriales SA, Shear NH, Gonzalez-Moreno EI. Liver involvement in the drug reaction, eosinophilia, and systemic symptoms syndrome. World J Clin Cases 2019; 7(6): 705-716 [PMID: 30968035 DOI: 10.12998/wjcc.v7.i6.705]
Corresponding Author of This Article
Emmanuel I Gonzalez-Moreno, MD, Assistant Professor, Staff Physician, Department of Medicine, Division of Gastroenterology, University of Calgary, Teaching, Research, and Wellness Building, 6D58, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada. emmanuel.gonzalezmor@ucalgary.ca
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 26, 2019; 7(6): 705-716 Published online Mar 26, 2019. doi: 10.12998/wjcc.v7.i6.705
Liver involvement in the drug reaction, eosinophilia, and systemic symptoms syndrome
Sylvia A Martinez-Cabriales, Neil H Shear, Emmanuel I Gonzalez-Moreno
Sylvia A Martinez-Cabriales, Neil H Shear, Department of Medicine, Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
Sylvia A Martinez-Cabriales, Internal Medicine Department, Dermatology Division, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, Mexico
Emmanuel I Gonzalez-Moreno, Department of Medicine, Division of Gastroenterology, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
Emmanuel I Gonzalez-Moreno, Internal Medicine Department, Gastroenterology Division, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, Mexico
Author contributions: Martinez-Cabriales SA designed research, performed research, analyzed data, wrote the paper, and approved the final manuscript version; Shear NH analyzed data, wrote the paper, and approved the final manuscript version; Gonzalez-Moreno EI designed research, performed research, analyzed data, wrote the paper, and approved the final manuscript version.
Conflict-of-interest statement: The authors have no conflict of interest and no financial support to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Emmanuel I Gonzalez-Moreno, MD, Assistant Professor, Staff Physician, Department of Medicine, Division of Gastroenterology, University of Calgary, Teaching, Research, and Wellness Building, 6D58, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada. emmanuel.gonzalezmor@ucalgary.ca
Telephone: +1-403-5925089
Received: September 5, 2018 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
Abstract
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.
