Clinical, biochemical, and serologic predictors of drug reaction with eosinophilia and systemic symptoms syndrome: A prospective case–control study - 27/04/21

Doi : 10.1016/j.jaad.2021.03.075

Rajat Choudhary, MBBS ^a, Keshavamurthy Vinay, MD, DNB ^a, Niharika Srivastava, PhD ^a, Anuradha Bishnoi, MD, DNB ^a, Divya Kamat, MD, DNB ^a, Davinder Parsad, MD ^a, Alka Bhatia, MD ^b, Muthu Sendhil Kumaran, MD, DNB, MNAMS ^a,^⁎
^a Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
^b Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

^∗Reprint requests: Muthu Sendhil Kumaran, MD, DNB, MNAMS, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.Department of Dermatology, Venereology and LeprologyPostgraduate Institute of Medical Education and ResearchChandigarh160012India

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Abstract

Background

Detailed scoring systems such as the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) score for validating a diagnosis of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome are available, but there is no rapid, easy tool to identify DRESS at presentation.

Objective

To identify the clinical, biochemical, and serologic markers predicting the DRESS syndrome and its severity.

Methods

In this prospective observational study, 25 patients with the DRESS syndrome and 25 control patients with maculopapular drug rash were recruited. Baseline clinical, biochemical, and serologic markers, such as high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate, and thymus and activation-regulated chemokine (TARC) levels, were recorded and their utility in identifying the DRESS syndrome at presentation and predicting severity was analyzed.

Results

The effectiveness of TARC level (>613.25 pg/mL), total body surface area (TBSA, >35%), hsCRP (>5 mg/L), eosinophils (>6%), absolute eosinophil count (>450 cells/mm³), and aspartate transaminase (>92 U/L) were statistically similar to the effectiveness of the RegiSCAR DRESS validation score (≥2) in diagnosing the DRESS syndrome. A combination model (TBSA at baseline, eosinophil count, and hsCRP) at the cutoff of 6.8 had a sensitivity of 96% and a specificity of 100%. Baseline serum TARC levels did not predict the DRESS severity or outcome.

Limitations

Small sample size.

Conclusion

The combination of TBSA involvement, eosinophil count, and hsCRP levels can predict the DRESS syndrome at presentation.

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Key words : DRESS, drug reaction, ESR, hsCRP, maculopapular drug reaction, TARC

Abbreviations used : AEC, ALP, ALT, AST, DRESS, ESR, hsCRP, MPE, RegiSCAR, ROC, TARC, TBSA, TLC

Plan

Introduction

Methods

Patients and controls

Baseline clinical and laboratory evaluation

Laboratory evaluation

Prediction of the DRESS syndrome by clinical, biochemical, and serologic markers

Parameters predicting internal organ involvement in DRESS

Discussion

Conclusion

	Drs Srivastava and Bishnoi contributed equally for the third authorship.
	Funding sources: Supported by the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) postgraduate thesis grant.
	IRB approval status: The study was approved by the Institutional Ethics Committee of the Postgraduate Institute of Medical Education and Research, Chandigarh, and was registered with the Clinical Trials Registry-India (CTRI/2020/03/023918).