Pediatric emergency medicine trisk 1306 1306
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distinguishing the two entities. If needed, topical steroids can help provide
symptomatic relief of pruritus.
DRUG HYPERSENSITIVITY REACTION (DHR)/DRUG
REACTION WITH EOSINOPHILIA AND SYSTEMIC
SYMPTOMS (DRESS)
The cutaneous eruption of DHR, also known as drug reaction with eosinophilia
and systemic symptoms (DRESS), is a morbilliform eruption that starts on the
face and spreads cephalocaudally. Additional clinical findings and systemic
involvement distinguish DHR from a skin-limited morbilliform drug eruption.
Facial edema is present in approximately 76%, fever in 90%, and
lymphadenopathy in 54% of patients with DHR. In half of patients, there can be
mild mucosal involvement, more commonly the oral mucosa. Systemic
involvement commonly manifests with eosinophilia (95%) or atypical
lymphocytosis (67%) on complete blood count. Liver involvement is seen in 75%
of patients, and often presents as elevation of liver transaminases. In cases where
patients have a prolonged clinical course or when they appear systemically ill,
echocardiogram, renal function tests, and coagulation profiles should be checked
for cardiac, renal, and hepatic involvement. Thyroid involvement is usually
delayed in onset, so thyroid functions should be followed for 2 to 3 months after
the DHR.
