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Drug reaction with eosinophilia and systemic symptoms: a clinicopathological study of six cases at a teaching hospital in midwestern Brazil

Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DIHS), is a severe adverse drug reaction characterized by multiple organ involvement. Additional features include extensive mucocutaneous eruption associated with fever, lymphadenopathy, liver dysfunction, and hematological changes. Other organs may be involved, particularly the kidneys, heart, lungs, and pancreas. This multivisceral involvement differentiates DRESS/DIHS from other drug-related skin reactions. Symptoms typically appear 2–8 weeks after introducing the medication and can persist or worsen for a period of weeks or months, even following discontinuation. Mortality rates of about 10% and incidences ranging from 1 : 1000 to 1 : 10,000 exposures have been reported. Recent studies have suggested a close relationship between human herpesvirus (HHV)-6 and the development of DRESS/DIHS, but the etiopathogenic mechanism has not been fully elucidated. Aromatic anticonvulsants, allopurinol, sulfonamides, and minocycline are the most frequently implicated drugs. The purpose of this study was to evaluate the clinical presentation, laboratory and histopathological findings, and prognosis of patients with DRESS/DIHS treated at the Hospital Universitario, a teaching hospital in Campo Grande (Mato Grosso do Sul state, in midwestern Brazil), between January 2011 and November 2013.