Xiaoxue Li,1,2,* Yanmei Li,1,2,* Lian Liu,1,2 Lian Wang,1,2 Lidan Zhang,1,2 Xian Jiang1,2 

1Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xian Jiang, Department of Dermatology, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Wuhou District, Chengdu, 610041, People’s Republic of China, Email jiangxian@scu.edu.cn

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe and potentially lethal adverse drug reaction. Its clinical complexity and heterogeneity pose challenges for diagnosis and management.
Methods: We retrospectively reviewed the medical records of patients with DRESS who were admitted to our hospital between 2013 and 2022. Data on demographics, culprit drugs, clinical manifestations, laboratory findings, and treatments were collected.
Results: Fifty-one patients were included in the final analysis, with 16 probable and 35 definite cases. The most common causative drugs were antiepileptic drugs (15.7%), anti-tuberculosis drugs (15.7%), and Chinese herbs (9.8%). Common skin manifestations included extensive skin involvement (76.5%), facial edema (66.7%), polymorphic maculopapular lesions (66.7%), and exfoliation (56.9%). Eosinophilia and atypical lymphocytes were noted in 96.1% and 68.6% of the patients, respectively. The liver is the most frequently affected organ. Facial edema, extensive skin involvement, and atypical lymphocytes were correlated with higher Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) scores (P< 0.05). DRESS induced by antiepileptic drugs, antituberculosis drugs, and Chinese herbs exhibited significant differences in platelet and lymphocyte counts, C-reactive protein (CRP) levels, and transaminase levels (P< 0.05).
Conclusion: Clinical manifestations of DRESS are complex. Facial edema, extensive skin involvement, and atypical lymphocytes have emerged as significant diagnostic indicators.

Keywords: drug reaction with eosinophilia and systemic symptoms, DRESS, antituberculosis drugs, antiepileptic drugs, Chinese herbs