DRUG-INDUCED HYPERSENSITIVITY SYNDROME (DRESS-SYNDROME) IN MONOZYGOTIC TWINS. A CASE FROM PRACTICE
Main Article Content
Abstract
Drug-induced hypersensitivity syndrome (drug rush with eosinophilia and systemic symptoms; DRESS-syndrome) is a variant of an allergic reaction with systemic manifestations and eosinophilia. DRESS-syndrome is a rare disease that occurs with a frequency of 1 : 1000 to 1 : 10000, but is characterized by a high mortality rate of up to 10%.
The article presents data from clinical observation of the course of an allergic reaction against the background of carbamazepine drug therapy in two identical male twin patients. The symptoms of DRESS-syndrome included diffuse skin rashes, febrile fever, enlarged lymph nodes, hypereosinophilia in the blood, hepatomegaly, and cytolysis syndrome. It is noted not only the similarity of the list of clinical manifestations of an adverse reaction, but also the synchronicity of their development.
Pathogenetic therapy led to a complete regression of skin syndrome, lymphadenopathy, fever, and cytolysis syndrome. The children were discharged in satisfactory condition on the 25th day from the moment of hospitalization.
Keywords
Article Details
Information about financing and conflict of interests
The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
1. Ivаnovа DA, Borisov SE. Profile and risk factors of adverse reactions in new tuberculosis cases receiving treatment. Tuberculosis and Lung Diseases. 2017; 95(6): 22-29. Russian (Иванова Д.А., Борисов С.Е. Спектр и факторы риска нежелательных побочных реакций при лечении впервые выявленных больных туберкулезом //Туберкулез и болезни легких. 2017. Т. 95, № 6. С. 22-29.) doi: 10.21292/2075-1230-2017-95-6-22-29
2. Vorzheva I.I., Chernyak B.A. Modern concepts of drug allergy to beta-lactam antibiotics: clinical and pathogenetic characteristics, specific diagnostics. Literature review. Practical Allergology. 2025; 1: 52-76. Russian (Воржева И.И., Черняк Б.А. Современные концепции лекарственной аллергии на бета-лактамные антибиотики: клинико-патогенетическая характеристика, специфическая диагностика. Обзор литературы //Практическая аллергология. 2025. № 1. С. 52-76.) doi: 10.46393/27129667_2025_52-76
3. Modern Concepts of drug hypersensitivity: a series of lectures for practicioners. Lecture 2. Practical Allergology. 2021; 2: 10-19.) doi: 10.46393/2712-9667_2021_2_10_19. Russian (Современные представления о лекарственной гиперчувствительности: цикл лекций для практикующих врачей. Лекция 2 //Практическая аллергология. 2021. № 2. С. 10-19.) doi: 10.46393/2712-9667_2021_2_10_19
4. Shamgunova BA, Demidov AA, Zaklyakova LV, Gorbunova OE, Kasymova EB, Zav'yalova IN. Drug-induced hypersensitivity reaction (DRESS syndrome) associated with reactivation of herpesvirus infection (clinical case). Modern problems of science and education. 2020; 4: 169-180. Russian (Шамгунова Б.А., Демидов А.А., Заклякова Л.В., Горбунова О.Е., Касымова Е.Б., Завьялова И.Н. Лекарственно-индуцированная реакция гиперчувствительности (DRESS-синдром), ассоциированная с реактивацией герпесвирусной инфекции (Клиническое наблюдение) //Современные проблемы науки и образования. 2020. № 4. С. 169-180.) doi: 10.17513/spno.30054
5. Mustafa SS, Ostrov D, Yerly D. Severe Cutaneous Adverse Drug Reactions: Presentation, Risk Factors, and Management. Curr Allergy Asthma Rep. 2018; 18(4): 26. doi: 10.1007/s11882-018-0778-6
6. Mori F, Caffarelli C, Caimmi S, Bottau P, Liotti L, Franceschini F, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS) in children. Acta Biomed. 2019; 90(3-S): 66-79. doi: 10.23750/abm.v90i3-S.8167
7. Behera SK, Das S, Xavier AS, Selvarajan S. DRESS syndrome: a detailed insight. Hosp Pract (1995). 2018; 46(3): 152-162. doi: 10.1080/21548331.2018.1451205
8 Mizukawa Y, Hirahara K, Kano Y, Shiohara T. Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms severity score: a useful tool for assessing disease severity and predicting fatal cytomegalovirus disease. J Am Acad Dermatol. 2019; 80(3): 670-678. doi: 10.1016/j.jaad.2018.08.052
9. Nguyen D, Vidal C, Chu H, van Nunen S. Human leukocyte antigen–associated severe cutaneous adverse drug reactions: from bedside to bench and beyond. Asia Pac Allergy. 2019; 9(3): e20. doi: 10.5415/apallergy.2019.9.e20
10. Dallakyan AG, Sergeeva EO. Some aspects of the pathogenetic mechanism of DRESS syndrome development. Nauchnyj al'manakh. 2023; 2: 36-39. Russian (Даллакян А.Г., Сергеева Е.О. Некоторые стороны патогенетического механизма развития DRESS-синдрома //Научный альманах. 2023. № 2-2(100). С. 36-39.)
11. Demko IV, Sobko EA, Ishchenko OP, Kraposhina AYu, Aristarkhova LV, Gordeeva NV, Dejkhina AS. DRESS/DIHS-sindrom, inducirovannyj priemom sul'fasalazina. Pulmonologiya. 2021; 31(6): 822-826. Russian (Демко И.В., Собко Е.А., Ищенко О.П., Крапошина А.Ю., Аристархова Л.В., Гордеева Н.В., Дейхина А.С. DRESS/DIHS-синдром, индуцированный приемом сульфасалазина //Пульмонология. 2021. Т. 31, № 6. С. 822-826.) doi: 10.18093/0869-0189-2021-31-6-822-826
12. Bochanova EN. Pharmacogenetics of antiepileptic drugs (literature review). Good Clinical Practice. 2017; (1): 51-55.. Russian (Бочанова Е.Н. Фармакогенетика противоэпилептических препаратов (обзор литературы) //Качественная клиническая практика. 2017. № 1. С. 51-57.) doi: 10.24411/2588-0519-2017-00008
13. Nasyrova RF, Sivakova NA, Lipatova LV, Ivashchenko DV, Sosina KA, Drokov AP, Shnajder NA. Biological markers of the antiepileptic drugs efficacy and safety: pharmacogenetics and pharmacokinetics. Siberian Medical Review. 2017; (1): 17-25. Russian (Насырова Р.Ф., Сивакова Н.А., Липатова Л.В., Иващенко Д.В., Сосина К.А., Дроков А.П., Шнайдер Н.А. Биологические маркеры эффективности и безопасности противоэпилептических препаратов: фармакогенетика и фармакокинетика //Сибирское медицинское обозрение. 2017. № 1. С. 17-25.) doi: 10.20333/2500136-2017-1-17-25
14. Zanger UM, Schwab M. Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation. Pharmacol Ther. 2013; 138: 103-141. doi: 10.1016/j.pharmthera.2012.12.007
15. Bloch KM, Sills GJ, Pirmohamed M, Alfirevic A. Pharmacogenetics of antiepileptic drug-induced hypersensitivity. Pharmacogenomics. 2014; 15(6): 857-868. doi: 10.2217/pgs.14.65
16. Yun J, Cai F, Lee FJ, Pichler WJ. T-cell-mediated drug hypersensitivity: immune mechanisms and their clinical relevance. Asia Pac Allergy. 2016; 6(2): 77-89. doi: 10.5415/apallergy.2016.6.2.77
17. Shnajder NA, Bochanova EN, Dmitrenko DV, Nasyrova RF. Farmakogenetika karbamazepina. Pharmacogenetics of carbamazepine. Epilepsy and paroxysmal conditions. Russian (Шнайдер Н.А., Бочанова Е.Н., Дмитренко Д.В., Насырова Р.Ф. Фармакогенетика карбамазепина //Эпилепсия и пароксизмальные состояния .2019, Т. 11, № 4. С. 364-378.) doi: 10.17749/2077-8333.2019.11.4.364-378
18. Sokolova NA, Pavlushkina LV, Shokhina OS, Gorshkova NA. Reactive eosinophilia in children with food allergies (clinical observations). Medical alphabet. 2020; (27): 40-42. Russian (Соколова Н.А., Павлушкина Л.В., Шохина О.С., Горшкова Н.А. Реактивные эозинофилии у детей при пищевой аллергии (клинические наблюдения) //Медицинский алфавит. 2020. № 27. С. 40-42.) doi: 10.33667/2078-5631-2020-27-40-42
19. Ostroumova OD, Shakhova EYu, Kochetkov AI. Drug-Induced Eosinophilia. Safety and Risk of Pharmacotherapy. 2019; 7(4): 176-189. Russian (Остроумова О.Д., Шахова ЕЮ, Кочетков АИ. Лекарственно-индуцированная эозинофилия //Безопасность и риск фармакотерапии. 2019. Т.7. №4. С.176–189.) doi: 10.30895/2312-7821-2019-7-4-176-189