DRESS/DIHS: a severe multisystem adverse drug reaction

Reakcija na lijek s eozinofilijom i sistemskim simptomima (DRESS, od engl. Drug Reactionwith Eosinophilia and Systemic Symptoms) ili jednostavnije sindrom preosjetljivostiuzrokovan lijekom (DIHS, od engl. Drug-Induced Hypersensitivity Syndrome) jedna je od teških,po život opasnih reakcija preosjetljivosti. DRESS/DIHS obilježava nagli nastup osipa s vrućicom,limfadenopatijom, eozinofilijom i atipičnom limfocitozom, hepatitisom te mogućimzahvaćanjem bubrega, pluća, srca, gušterače ili drugih organa. Zbog odgođenog nastupa nakonpočetka primjene uzročnog lijeka, kao i zbog raznolikosti u kliničkoj simptomatologiji,ovaj je sindrom često neprepoznat ili je njegova dijagnoza odgođena. DRESS/DIHS je najčešćeuzrokovan antiepilepticima, ali se povezuje i s brojnim drugim lijekovima. U podlozi bolestinajvjerojatnije se nalazi složena interakcija između samog lijeka, reaktivacije herpes virusa ineadekvatnog imunološkog odgovora. Ishod ovog akutnog oboljenja varira od potpunog oporavkado trajnih sistemskih posljedica, uključujući i pojavu autoimunih bolesti.The syndrome termed Drug Reaction with Eosinophilia and Systemic Symptoms(DRESS), also known as Drug-Induced Hypersensitivity Syndrome (DIHS) is a severe, lifethreatening,multiorgan adverse drug reaction. It is characterized by an abrupt onset offever and rash, lymphadenopathy, eosinophilia, atypical lymphocytes, liver damage aswell as possible involvement of kidney, lungs, heart, pancreas or other organs. Due to thedelayed onset after the introduction of the culprit drug and a variety of clinicalmanifestations, DRESS/DIHS is frequently unrecognized or its diagnosis is delayed. It ismost commonly caused by anticonvulsants, but various other drugs have been implicatedin its onset. The pathogenesis includes a complex interplay between drugs, reactivation ofherpes viruses and altered immune response. Outcome of the disease varies fromcomplete recovery to permanent systemic complications including development ofautoimmune diseases