Mizukawa et al reported a score determining the severity of drug hypersensitivity syndrome (drug reaction with eosinophilia and systemic symptoms, DHS, DRESS). The authors are from Kyorin University and Saitama Medical University in Japan.
Patient selection: DHS/DRESS
Scoring is done: within 3 days of onset, 2-4 weeks after; as needed
Parameters:
(1) age in years
(2) duration of drug exposure after onset, in days
(3) allopurinol exposure
(4) pulsed prednisone (IV methylprednisone >= 50 mg for 3 days)
(5) percent of body surface area showing erythema
(6) percent of body surface area showing erosions
(7) number of days with fever (>= 38.5°C)
(8) number of days with anorexia (<= 70% of regular food intake)
(9) serum creatinine in mg/dL
(10) serum ALT in IU/L
(11) serum CRP in mg/dL
|
Parameter |
Finding |
Points |
|
age in years |
<= 40 years |
-1 |
|
|
41 to 74 |
0 |
|
|
>= 75 years |
2 |
|
duration of drug exposure |
<7 days |
0 |
|
|
>= 7 days |
1 |
|
allopurinol exposure |
no |
0 |
|
|
yes |
1 |
|
pulsed prednisone |
no |
0 |
|
|
yes |
2 |
|
percent BSA erythema |
< 70% |
0 |
|
|
>= 70% |
1 |
|
|
erythroderma |
2 |
|
percent BSA erosions |
< 10% |
0 |
|
|
10 to 29% |
1 |
|
|
>= 30% |
3 |
|
number of days with fever |
0 or 1 days |
0 |
|
|
2 to 6 days |
1 |
|
|
>= 7 days |
2 |
|
anorexia duration |
< 5 days |
0 |
|
|
>= 5 days |
1 |
|
serum creatinine |
< 1.0 mg/dL |
0 |
|
|
1.0 to 2.0 mg/dL |
1 |
|
|
>= 2.1 mg/dL |
3 |
|
|
hemodialysis |
3 |
|
serum ALT |
< 400 IU/L |
0 |
|
|
400 to 1000 IU/L |
1 |
|
|
> 1000 IU/L |
2 |
|
CRP |
<= 2 mg/dL |
-1 |
|
|
2 to 9.9 mg/dL |
0 |
|
|
10 to 14.9 mg/dL |
1 |
|
|
>= 15.0 mg/dL |
2 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -2
• maximum score: 21 syndrome
• The higher the score the more severe the condition.
• If done sequentially then the disease trend can be followed.
Specialty: Dermatology
