Successful treatment of drug reaction with eosinophilia and systemic symptoms secondary to multiple viral infections and nonsteroidal anti-inflammatory drugs in a patient with autoimmune hepatitis
Shengwu Chuai, Yanhong Gao, Ran Wang, Qianqian Li, Xuyong Lin, Ting Wang, Xingshun QiRationale:
Drug reaction with eosinophilia and systemic symptoms (DRESS), a potentially life-threatening drug-induced adverse reaction, can damage various organs, but is under-recognized in clinical practice.
Patient concerns:
A 44-year-old female was admitted due to abnormal liver function for half a month. During hospitalization, she developed fever, rash, pleural effusion, and multiple organ dysfunction.
Diagnoses:
Probable DRESS was considered, except for cytomegalovirus, circovirus, Epstein–Barr virus, and herpes simplex virus infection as well as autoimmune hepatitis.
Interventions:
Antiviral and antibacterial infection drugs and nonsteroidal anti-inflammatory drugs were used, but fever was not improved. After the diagnosis of “probable DRESS,” methylprednisolone and immunoglobulin were added. Then, fever was controlled.
Outcomes:
Finally, her temperature normalized, and rashes around right quadrant abdomen and limbs gradually decreased. Lung computed tomography scan was repeated, indicating the improvement of pneumonia and pleural effusion. Serum bilirubin and immunoglobulin G levels also decreased.
Lessons:
DRESS should be considered in a patient suffering from viral infection and receiving potentially causative drugs, when fever, rash, and multiple organ dysfunction occur.