DRESS syndrome tied to high risk of complications in elderly, mainly kidney involvement and sepsis: Study

The retrospective cohort study comprising patients hospitalized for DRESS revealed that the clinical characteristics were frequently observed in those aged ≥65 years including sepsis at initial presentation, renal impairment, and drug reactions from allopurinol use.

Drug reaction with eosinophilia and systemic symptoms, also known as drug-induced hypersensitivity syndrome and by various other names, is a rare drug reaction characterized by eosinophilia, a skin rash, and organ involvement. It is recognized as one of the severe cutaneous adverse reactions (SCAR) and can be potentially life-threatening with a high mortality rate of 10%. Historically, it was most frequently linked with phenytoin and was initially described as phenytoin hypersensitivity syndrome.

Khaoula Trimeche, Hedi Chaker University Hospital, El Ain, Tunisia, and colleagues aimed to focus on the clinical and epidemiological characteristics of DRESS in the elderly and to identify the incriminated drugs.

The retrospective study included patients hospitalized for DRESS with a RegiSCAR ≥4. 55 patients were divided into two groups according to age: 65 years or older (G1; 30.9%) and <65 years (G2; 69.1%). Comparative and multivariate analyses were used to perform the statistical study.

The study revealed the following findings:

• Skin manifestations were comparable in both groups.
• Lymphadenopathy was less common in G1 with a statistically significant difference.
• Renal impairment was more frequent in the elderly with a statistically significant result.
• DRESS in the elderly group was significantly associated with the occurrence of sepsis.
• Allopurinol was the most common culprit associated with DRESS in G1.
• Relapses and recurrences were comparable in both groups.

"In the elderly, DRESS is associated with a high complications risk, mainly sepsis and kidney involvement," the researchers wrote. "Allopurinol is the most incriminated drug."

Reference:

Emna Bahloul, Khaoula Trimeche, Khadija Sellami, Fatma Hammami, Faten Hayder, Rim Chaabouni, Meriem Amouri, Abderrahmen Masmoudi, Madiha Mseddi, Sonia Boudeya, and Hamida Turki.