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Prevalence, risk factors, and mortality outcome in the drug reaction with eosinophilia and systemic symptoms patients with cardiac involvement
Author(s) -
Intarasupht Julphat,
Kanchanomai Anchisa,
Leelasattakul Wuttirak,
Chantrarat Thoranis,
Nakakes Artit,
Tiya Waraporn
Publication year - 2018
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.14174
Subject(s) - medicine , culprit , eosinophilia , drug , mortality rate , surgery , pharmacology , myocardial infarction
Background Drug reaction with eosinophilia and systemic symptoms ( DRESS ) syndrome is a severe cutaneous drug reaction that can affect multiple internal organ systems. Cardiac involvement in DRESS syndrome (CiDs) is uncommon but can be life‐threatening. Objective To determine the prevalence, risk factors, and mortality outcome of CiDs. Material and methods Forty‐one patients who were diagnosed with probable and definite DRESS syndrome according to the Regi SCAR criteria were recruited. Cardiac involvement was evaluated by two independent cardiologists. Results The cardiac involvement was found in 8/41 (19.5%) patients. Specifically, myocardial involvement was found in five patients, while three patients had pericardial involvement. The majority of culprit drugs were antibiotics followed by anti‐epileptic medications. The hemoglobin and albumin levels were significantly lower in the patients with CiDs when compared to the patients without CiDs ( P ‐value = 0.005 for both factors). The mortality rate at 30 and 90 days was significantly higher among CiDs patients, that is, 3/8 (37.5%) versus 2/28 (6.1%); P ‐value = 0.02 and 4/8 (50.0%) versus 2/33 (6.1%); P ‐value = 0.002 respectively. Conclusion Our study showed the prevalence of CiDs was as high as 19.5% with high mortality rate. We suggest a thorough cardiac evaluation in all DRESS patients with Regi SCAR score ≥4. The patients with CiDs had significantly lower hemoglobin and albumin levels, which might imply poor health condition, when compared to those without CiDs.