Yoshiko Mizukawa1, Kazuhisa Hirahara2, Yoko Kano3, Tetsuo Shiohara3. 1. Department of Dermatology at Kyorin University School of Medicine, Shinkawa, Mitaka, Tokyo, Japan. Electronic address: ymizu@ks.kyorin-u.ac.jp. 2. Department of Dermatology at Kyorin University School of Medicine, Shinkawa, Mitaka, Tokyo, Japan; Department of Dermatology, Saitama Medical University, Saitama Medical Center, Kawagoe, Saitama, Japan. 3. Department of Dermatology at Kyorin University School of Medicine, Shinkawa, Mitaka, Tokyo, Japan.
Abstract
BACKGROUND: The prognosis of drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is highly unpredictable. Severe complications, either related or unrelated to cytomegalovirus (CMV) reactivation, are a highly probable cause of death. OBJECTIVES: The aim was to establish a scoring system for DiHS/DRESS that can be used to monitor severity, predict prognosis, and stratify the risk of developing CMV disease and complications. METHODS: A retrospective analysis of 55 patients with DiHS/DRESS was performed. A composite score was created using clinical data. DiHS/DRESS patients were also stratified into 3 groups based on the scores to predict the risk of CMV reactivation and complications. RESULTS: This scoring system made it possible to predict CMV disease and complications. Scores ≥4 were associated with the later development of CMV disease and complications, while no patients with scores <4 developed complications. LIMITATIONS: This was a single-institution study with a relatively small patient cohort that lacked a validation cohort. CONCLUSIONS: Our scoring system may be useful for predicting CMV-related complications, and early intervention with anti-CMV agents should be considered in patients with scores ≥4 or with evidence of CMV reactivation.
BACKGROUND: The prognosis of drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is highly unpredictable. Severe complications, either related or unrelated to cytomegalovirus (CMV) reactivation, are a highly probable cause of death. OBJECTIVES: The aim was to establish a scoring system for DiHS/DRESS that can be used to monitor severity, predict prognosis, and stratify the risk of developing CMV disease and complications. METHODS: A retrospective analysis of 55 patients with DiHS/DRESS was performed. A composite score was created using clinical data. DiHS/DRESS patients were also stratified into 3 groups based on the scores to predict the risk of CMV reactivation and complications. RESULTS: This scoring system made it possible to predict CMV disease and complications. Scores ≥4 were associated with the later development of CMV disease and complications, while no patients with scores <4 developed complications. LIMITATIONS: This was a single-institution study with a relatively small patient cohort that lacked a validation cohort. CONCLUSIONS: Our scoring system may be useful for predicting CMV-related complications, and early intervention with anti-CMV agents should be considered in patients with scores ≥4 or with evidence of CMV reactivation.
Authors: Felix L Chan; Neil H Shear; Nidhi Shah; Cristina Olteanu; Rena Hashimoto; Roni P Dodiuk-Gad Journal: Drug Saf Date: 2020-02 Impact factor: 5.228
Authors: A Herman; M Matthews; M Mairlot; L Nobile; L Fameree; L-M Jacquet; M Baeck Journal: J Eur Acad Dermatol Venereol Date: 2020-07-31 Impact factor: 6.166