DRESS Syndrome Analysis

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, also known as drug-induced hypersensitivity Syndrome (DIHS) presents clinically as an extensive mucocutaneous rash, accompanied by fever, lymphadenopathy, hepatitis, hematologic abnormalities with eosinophilia and atypical lymphocytes, and may involve other organs with resultant damage in several systems. The pathogenesis is related to specific drugs (especially the aromatic anticonvulsants), altered immune response, sequential reactivation of herpes virus, and association with some HLA alleles. DRESS usually occurs two to eight weeks after the initiation of a medication. Although the pathophysiology of DRESS syndrome remains unknown, eosinophilic infiltration is probably …show more content…
It is characterized by: the presence of abnormal gastrointestinal symptoms, most often abdominal pain, eosinophils infiltration in one or more areas of the gastrointestinal tract, defined as 20 or more eosinophils per high-power field, the absence of an identified cause of eosinophilia and the exclusion of eosinophilic involvement in organs other than the gastrointestinal tract. A history of atopy or food allergy is often present. The entire gastrointestinal tract can be involved. The stomach is the organ most commonly affected, followed by small intestine and colon[26]. In our case, the biopsy from stomach revealed eosinophilic infiltration of the gastric mucosa. It is reported to be more common in men with a ratio of 3:2[4,5,6,7]. Clinical symptoms are non specific and depend upon the organ(s) involved. Patients of EGE are divided by the Klein classification into those with predominantly mucosal, muscle layer or subserosal disease. However, the mucosal form is the most common[27].Clinical manifestations range from non-specific gastrointestinal complaints to more specific symptoms such as protein-losing enteropathy, luminal obstruction and eosinophilic ascites. Peripheral eosinophilia is common in all subtypes of EGE and is noted in 60-80% of the patients[28]. Endoscopic findings may be nonspecific and can range from erythema and friability to erosions and …show more content…
Eosinophils can serve as major effector cells, inducing tissue damage and dysfunction by releasing toxic granule proteins (major basic protein [MBP], eosinophilic cationic protein [ECP], eosinophil peroxidase [EPO], and eosinophil derived neurotoxin [EDN]) and lipid mediators, which are cytotoxic. In eosinophilic gastroenteritis (EGE) cytokines interleukin (IL)-3, IL-5 and granulocyte macrophage colony stimulating factor may be responsible for the recruitment and activation of eosinophils and hence the pathogenesis. Atopy is present in a subset of patients. However, studies also have shown non-IgE mediated mechanisms. Eosinophilic gastroenteritis runs a chronic and relapsing

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