Turkiye Klinikleri Journal of Medical Sciences

.: CASE REPORTS
COVID-19 Hastasında Gelişen Dress Sendromu Olgusu: İlaca Bağlı mı, Hastalığa Bağlı mı?
Dress Syndrome Case in COVID-19 Patient: Drug-Induced or Disease-Related?
Elif Nihal BAŞERa, Selami Aykut TEMİZb, Arzu ATASEVENa
aNecmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi, Deri ve Zührevi Hastalıklar ABD, Konya, TÜRKİYE
bKonya Ereğli Devlet Hastanesi, Deri ve Zührevi Hastalıkları Kliniği, Konya, TÜRKİYE
Turkiye Klinikleri J Med Sci.2020;40(4):475-9
doi: 10.5336/medsci.2020-78921
Article Language: TR
Full Text
ÖZET
 Eozinofili ve sistemik semptomlarla ilaç reaksiyonu [Drug rash with eoshinophilia and systemic symptoms (DRESS)] sendromu nadir görülen, yaklaşık %10 oranında mortal seyredebilen ilaç reaksiyonlarından biridir. DRESS sendromu, klinik olarak yaygın makülopapüler ekzantem, çeşitli hematolojik anormallikler, karaciğer ve böbrek fonksiyon bozuklukları, ateş ve lenfadenopati ile karakterizedir. DRESS sendromunun etiyolojisinde pek çok ilaç bulunup Fenitoin, Karbamazepin, fenobarbital, Allopürinol, Abakavir ve Sülfonamidler en çok bildirilenlerdendir. Hidroksiklorokin , in vitro gösterilen antiviral etkileri nedeni ile koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] hastalığına karşı tedavide kullanılmaktadır. Hidroksiklorokinin, literatürde bildirilen dermatolojik yan etkilerinden bazıları; alopesi, ciltte hiperpigmentasyon ve kaşıntı olup, aşırı duyarlılık reaksiyonları olan Steven-Johnson sendromu/toksik epidermal nekroliz, akut generalize ekzantematöz püstüloz ve DRESS sendromu da bildirilmiştir. Biz burada, COVID-19 hastalığı tedavisi sırasında gelişen yaygın cilt döküntüsü ve sistemik bulguları ile DRESS sendromu tanısı koyduğumuz bir olgumuzu, pandemi döneminde gelişebilecek ilaç reaksiyonları ve COVID-19'a bağlı deri tutulumlarına dikkat çekmek açısından sunmak istedik. Aynı zamanda, COVID-19 hastalığı seyrindeki ilaç reaksiyonu ve cilt tutulumu karmaşasına dikkat çekmek istedik.

Anahtar Kelimeler: COVID-19; DRESS sendromu; ilaç aşırı duyarlılığı
ABSTRACT
 Drug rash with eoshinophilia and systemic symptoms (DRESS) syndrome is one of the rare drug reactions with a mortality rate of approximately 10%. Clinically the DRESS syndrome is characterized by diffuse maculopapular exanthema, various hematological abnormalities, liver and kidney dysfunction, fever, and lymphadenopathy. There are many drugs in the etiology of DRESS syndrome, and Phenytoin, Carbamazepine, phenobarbital, Allopurinol, Abacavir and Sulfonamides are among the most reported. Hydroxychloroquine is used in the treatment of COVID-19 disease due to its antiviral effects shown in vitro. Some of the dermatological side effects of Hydroxychloroquine reported in the literature are alopecia, hyperpigmentation and itching of the skin, as well as Steven-Johnson syndrome/toxic epidermal necrolysis, acute generalized exantomatous pustulosis, DRESS syndrome, which are hypersensitivity reactions. Here, we wanted to present a patient who was diagnosed as DRESS syndrome due to his widespread skin rash and systemic signs that developed during the treatment of COVID-19 disease in order to draw attention to the drug reactions that may develop during the pandemic and skin involvement due to COVID-19. At the same time, we wanted to draw attention to the complexity of drug reaction or skin involvement in the course of COVID-19 disease.

Keywords: COVID-19; DRESS syndrome; drug hypersensitivity
REFERENCES:
  1. De A, Rajagopalan M, Sarda A, DasS, Biswas P. Drug reaction with eosinophilia and systemic symptoms: an update and review ofrecent literature. Indian J Dermatol. 2018;63(1):30-40.[Crossref] [PubMed] [PMC] 
  2. Ferahbaş Kesikoğlu A. [Adverse drug reactions (maculopapular, AGEP,DRESS)]. Turkiye Klinikleri J Dermatol-Special Topics. 2016;9(4):15-7.[Link] 
  3. White KD, Chung WH, Hung SI,Mallal S, Phillips EJ. Evolving models of the immunopathogenesis of T cell-mediated drugallergy: the role of host, pathogens, and drug response. J Allergy Clin Immunol.2015;136(2):219-34.[Crossref] [PubMed] [PMC] 
  4. Castro Jiménez A, NavarreteNavarrete N, Gratacós Gómez AR, Florido López F, García Rodríguez R, Gómez Torrijos E, etal. First case of DRESS syndrome caused by hydroxychloroquine with a positive patch test.Contact Dermatitis. 2020;12:10.1111/cod.13657.[Crossref] [PubMed] [PMC] 
  5. Schrezenmeier E, Dörner T.Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology.Nat Rev Rheumatol. 2020;16(3):155-66.[Crossref] [PubMed] 
  6. Hashem AM, Alghamdi BS, AlgaissiAA, Alshehri FS, Bukhari A, Alfaleh MA, et al. Therapeutic use of chloroquine andhydroxychloroquine in COVID-19 and other viral infections: A narrative review. Travel MedInfect Dis. 2020;35:101735.[Crossref] [PubMed] [PMC] 
  7. Davoodi L, Jafarpour H,Kazeminejad A, Soleymani E, Akbari Z, Razavi A, et al. Hydroxychloroquine-inducedStevens-Johnson syndrome in COVID-19: a rare case report. Oxf Med Case Reports.2020;25;2020(6):omaa042.[Crossref] [PubMed] [PMC] 
  8. Juurlink DN. Safety considerationswith chloroquine, hydroxychloroquine and azithromycin in the management of SARS-CoV-2infection. CMAJ. 2020;27;192(17):E450-E3.[Crossref] [PubMed] [PMC] 
  9. Freeman EE, McMahon DE, Lipoff JB,Rosenbach M, Kovarik C, Desai SR, et al. The spectrum of COVID-19-associated dermatologicmanifestations: An international registry of 716 patients from 31 countries. J Am AcadDermatol. 2020;83(4):1118-29.[Crossref] [PubMed] [PMC] 
  10. Chen CB, Abe R, Pan RY, Wang CW,Hung SI, Tsai YG, et al. An updated review of the molecular mechanisms in drughypersensitivity. J Immunol Res. 2018;13;2018:6431694.[Crossref] [PubMed] [PMC] 
  11. Husain Z, Reddy BY, Schwartz RA.DRESS syndrome: part II. management and therapeutics. J Am Acad Dermatol.2013;68(5):709.e1-9.[Crossref] [PubMed] 
  12. Delaleu J, Deniau B, Battistella M, de Masson A, Bensaid B, Jachiet M,et al. Acute generalized exanthematous pustulosis induced by hydroxychloroquine prescribedfor COVID-19. J Allergy Clin Immunol Pract. 2020;8(8):2777-9.e1.[Crossref] [PubMed] [PMC] 
  13. Litaiem N, Hajlaoui K, Karray M,Slouma M, Zeglaoui F. Acute generalized exanthematous pustulosis after COVID-19 treatmentwith hydroxychloroquine. Dermatol Ther. 2020;33(4):e13565.[Crossref] [PubMed] [PMC] 
  14. Grandolfo M, Romita P, BonamonteD, Cazzato G, Hansel K, Stingeni L, et al. Drug reaction with eosinophilia and systemicsymptoms syndrome to hydroxychloroquine, an old drug in the spotlight in the COVID-19 era.Dermatol Ther. 2020;33(4):e13499.[Crossref] [PubMed] [PMC] 
  15. Herman A, Matthews M, Mairlot M,Nobile L, Fameree L, Jacquet LM, et al. Drug reaction with eosinophilia and systemicsymptoms syndrome in a patient with COVID-19. J Eur Acad Dermatol Venereol.2020;31:10.1111/jdv.16838.[Crossref] [PubMed] [PMC] 
  16. Akcam FZ, Aygun FO, Akkaya VB.DRESS like severe drug rash with eosinophilia, atypic lymphocytosis and fever secondary toceftriaxone. J Infect. 2006;53(2):e51-3.[Crossref] [PubMed] 
  17. Prados-Casta-o M, Pi-ero-SaavedraM, Leguísamo-Milla S, Ortega-Camarero M, Vega-Rioja A. DRESS syndrome induced by meropenem.Allergol Immunopathol (Madr). 2015;43(2):233-5.[Crossref] [PubMed] 
  18. Blair PW, Herrin D, Abaalkhail N,Fiser W. DRESS syndrome presenting after initiation of mycobacterium avium complexosteomyelitis treatment. BMJ Case Rep. 2015;5;2015:bcr2015210907.[Crossref] [PubMed] [PMC] 
  19. Su HH, Hsu CC, Fang CK. Suspecteddrug reaction with eosinophilia and systemic symptoms (DRESS) secondary to quetiapine in anelderly patient. Int J Gerontol. 2014;8:45.[Crossref] 
  20. Dursun R, Temiz SA. The clinicsof HHV-6 infection in COVID-19 pandemic: pityriasis rosea and Kawasaki disease. DermatolTher. 2020;33(4):e13730.[Crossref] [PubMed] [PMC] 
  21. Jamiolkowski D, Mühleisen B,Müller S, Navarini AA, Tzankov A, Roider E, et al. SARS-CoV-2 PCR testing of skin forCOVID-19 diagnostics: a case report. Lancet. 2020;29;396(10251):598-9.[Crossref] [PubMed] [PMC] 

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