Cervigón GI, Sandín SS, Pérez HC, Bahillo MC, Vélez PC, García AD

Idioma: Español
Referencias bibliográficas: 31
Paginas: 120-126
Archivo PDF: 406.56 Kb.

RESUMEN

El síndrome de DRESS es una toxicodermia grave caracterizada por exantema, fiebre, adenopatías, alteraciones hematológicas (eosinofilia, linfocitos atípicos) y afectación de órganos internos.
Los anticonvulsivantes aromáticos y las sulfonamidas son los fármacos que con mayor frecuencia se asocian a esta entidad clínica.
El diagnóstico se establece por la exposición al fármaco, los hallazgos clínicos y de laboratorio y el diagnóstico diferencial con otras enfermedades.
El manejo terapéutico incluye la rápida retirada del fármaco responsable, el tratamiento de soporte y la prevención de la sepsis. El uso de corticoesteroides sistémicos resulta controvertido.
Presentamos un caso de síndrome de DRESS por sulfonamidas con grave afectación multiorgánica. Con la corticoterapia sistémica se obtuvo una importante mejoría clínica y analítica, por lo que recomendamos su uso cuando existe afectación importante de órganos internos.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Bouquet H, Bagot M, Roujeau JC. Druginduced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinphilia and Systemic Symptoms: DRESS). Semin Cutan Med Surg 1996;1 250-7.

2. Sontheimer R, Houpt K. DIDMOHS: a proposed consensus nomenclature for the drug-induced delayed multiorgan hypersensitivity syndrome. Arch Dermatol 1998;134:874-5.

3. Sullivan J, Shear N. The drug hypersensitivity syndrome. What is the pathogenesis? Arch Dermatol 2001;137:357-64.

4. Tomecki K, Catalano C. Dapsone hypersensitivity. The sulfone syndrome revisited. Arch Dermatol 1981;117:38-39.

5. Queyrel V, Catteau B, Michon-Pasture U, et al. DRESS syndrome à la sulfasalazine et à la carbamazépine: à propos de deux cas. Rev Med Interne 2001;22:582-6.

6. Fernández-Chico N, Bielsa Marsol I. Síndrome de hipersensibilidad a fármacos. Piel 2003;18:252-8.

7. Descamps V, Valance A, Edlinger C, Fillet AM, Grossin M, Lebrun-Vignes B, Belaich S, Crickx B. Association of human herpesvirus 6 infection with drug reaction with eosinophilia and systemic symptoms. Arch Dermatol 2001; 137:301-4.

8. Callot V, Roujeau JC, Bagot M, et al. Drug-induced pseudolymphoma and hypersensitivity syndrome. Arch Dermatol 1996; 132:1315-21.

9. Wolkenstein P, Chosidow O. Toxidermies avec atteinte pulmonaire. Rev Mal Respir 2003;20:719-26.

10. King G, Barnes D, Hayes M. Carbamazepineinduced pneumonitis. Med J Aust 1994;160: 126-7.

11. Toyoshima M, Sato A, Hayakawa H, Taniguchi M, Imokawa S, Chida K. A clinical study of minocycline-induced pneumonitis. Intern Med 1996;35:176-9.

12. Angle P, Thomas P, Chiu B, Freedman J. Bronchiolitis obliterans with organizating pneumonia and cold agglutinin disease associated with phenytoin hypersensitivity syndrome. Chest 1997;112:1697-9.

13. Ghislain PD, Roujeau JC. Treatment of severe drug reactions: Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis and Hypersensitivity syndrome. Dermatol Online 2002;8:5.

14. Tas S, Simonart T. Management of Drug Rash with Eosinophilia and Systemic Symptoms (DRESS Syndrome): An Update. Dermatology 2003;206:353-6.

15. Bachot N, Roujeau JC. Differential Diagnosis of Severe Cutaneous Drug Eruptions. Am J Clin Dermatol 2003;4:561-72.

16. Michael JR, Mitch WE. Reversible renal failure and myositis caused by phenytoin hypersensitivity. JAMA 1976;236:2773-4.

17. Kleier R, Breneman D, Boiko S. Generalized pustulation as a manifestation of the hypersensitivity syndrome. Arch Dermatol 1991;127:1361-4.

18. Chopra S, Levell NJ, Cowley G, Gilkes JJH. Systemic corticosteroids in the phenytoin hypersensitivity syndrome. Br J Dermatol 1996;1334:1109-12.

19. Rojeau JC. Treatment of severe drug eruptions. J Dermatol 1999;26:718-22.

20. Callot V, Roujeau JC, Bagot M, Wechsler J, Chosidow O, Souteyrand P, Morel P, Dubertret L, Avril MF, vuz J. Drug-induced pseudolymphoma and hypersensitivity syndrome: Two different clinical entities. Arch Dermatol 1996;132:1315-21.

21. Hellman C, Lonnkvist K, Hedlin G, Hallden G, Lundahl J. Down-regulated IL-5 receptor expresion on peripheral blood eosinophilis from butesonide-treated children with asthma. Allergy 2002;54:323-28.

22. Weller PF, Bubley GJ. The idiopathic hyperosinophilic syndrome. Blood 1994;83: 2759-79.

23. Rojeau JC, Stern RS. Severe adverse reactions to drugs. N Engl J Med 1994;331: 1272-85.

24. Hallebian PH, Corder VJ, Madden MR, Finklestein JL, Shires GT. Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg 1986;204:503-12.

25. Redondo P, de Felipe I, de la Pena A, Aramendia JM, Vanaclocha V. Druginduced hypersensitivity syndrome and toxic epidermal necrolysis: Treatment with N-acetylcisteine. Br J Dermatol 1997;136: 645-6.

26. Simonart T, Tugendhaft P, Vereecken P, De Dobbeler G, Heenen M. Hazards of therapy with high doses of N-acetylcisteine for anticonvulsant-induced hypersensitivity syndrome. Br J Dermatol 1998;138:553.

27. Vélez A, Moreno JC. Toxic epidermal necrolysis treated with N-acetylcisteine. J AM Acad Dermatol 2002;46:469-70.

28. Moldeus P, Quangan J. Impor tance of the glutathione cycle in drug metabolism. Pharmacol Ther 1987;33:37-40.

29. Tas S, Simonart, Heene M. Angio-oedema caused by high doses of N-acetylcisteine in patients with hypersensitivity syndrome. Br J Dermatol 2001;145:856-7.

30. Fitton A, Goa KL. Lamotrigine: An update of its pharmacology and therapeutic use in epilpsy. Drugs 1995;50:691-713.

31. Moreno-Ancillo A, López-Serrano MC. Hypersensitivity reactions to drugs in HIVinfected patients: Allergic evauation and desensitization. Clin Exp Allergy 1998;28: 57-60.