Criteria for the Diagnosis of Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

Description

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) is a designation proposed to replace the term Hypersensitivity Syndrome. This syndrome involves a severe idiosyncratic reaction to a drug, with a severe cutaneous eruption, fever, lymphadenopathy, and involvement of multiple organs. If unrecognized, the process can be fatal in 10% of patients, while drug cessation and corticosteroid therapy can result in clinical improvement.

Implicated drugs:

(1) anticonvulsants, including phenytoin and hydantoin

(2) sulfonamides, dapsone and sulfasalazine

(3) less often: minocycline, calcium channel blockers, thalidomide, ranitidine, zalcitabine, allopurinol and other drugs

Criteria for the diagnosis of DRESS:

(1) cutaneous drug eruption

(2) hematologic abnormality: one or both of the following

(2a) eosinophilia >= 1,500 per µL

(2b) presence of atypical lymphocytes

(3) systemic involvement: one or more of the following

(3a) lymphadenopathy >= 2 cm in diameter

(3b) hepatitis (liver transaminase values >= 2 times normal)

(3c) interstitial nephritis

(3d) interstitial pneumonitis

(3e) carditis

Interpretation:

• A person is said to have DRESS if all 3 criteria are present.

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Description

Specialty

ICD-10