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전자의무기록을 이용한 DRESS (drug reaction with eosinophilia and systemic symptoms) 증후군 탐색
강동윤 ( Dong Yoon Kang ),장동연 ( Dong Yeon Jang ),손경희 ( Kyung Hee Sohn ),강성윤 ( Sung Yoon Kang ),김주영 ( Ju Young Kim ),조상헌 ( Sang-heon Cho ),강혜련 ( Hye-ryun Kang ) 대한천식알레르기학회 2018 Allergy Asthma & Respiratory Disease Vol.6 No.3
Purpose: Since drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is very rare and difficult to diagnose, its exact epidemiology is still unknown. If screening tools based on laboratory results or electronic medical records are available, the occurrence of DRESS syndrome can be monitored in real time. Methods: To screen cases with DRESS syndrome, all the results of both eosinophil and alanine transaminase (ALT) level from July 2014 to June 2015 were analyzed by 36 searching conditions for the signal detection of 7 definite DRESS cases among 199,924 patients during the study period. Those searching conditions were diverse combinations of different cutoff levels of eosinophil and ALT with or without nursing records presenting skin symptoms. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated for individual searching conditions. Results: As cutoff levels of eosinophil and ALT for screening DRESS increased from 3% to 5% and 40 U/L to 300 U/L, respectively, the sensitivity decreased from 100% to 42.9% and the PPV increased from 0.06% to 13.0%. A combination of eosinophil >10% and ALT >300 U/L which had the highest PPV among 36 search conditions could detect DRESS syndrome by sensitivity 42.9% and PPV 13.0%. When nursing records for skin symptoms were added, PPV was augmented to 21.4%. Conclusion: A combination of eosinophil and ALT levels is a useful search condition for the screening of DRESS syndrome. Nursing records can provide an additional increment in PPV. (Allergy Asthma Respir Dis 2018;6:149-154)
1차 및 2차 항결핵제에 의한 DRESS (drug reaction with eosinophilia and systemic symptom) 증후군 1예와 문헌 고찰
황영훈 ( Young-hoon Hwang ),장동연 ( Dong Yeon Jang ),강성윤 ( Sung Yoon Kang ),손경희 ( Kyung-hee Sohn ),강동윤 ( Dong Yoon Kang ),이창훈 ( Chang Hoon Lee ),강혜련 ( Hye-ryun Kang ) 대한천식알레르기학회 2017 Allergy Asthma & Respiratory Disease Vol.5 No.2
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal drug-induced systemic hypersensitivity response characterized by erythematous eruption, fever, leukocytosis with eosinophilia, and internal organ involvement. Antitubercular agents are potential causative agents for DRESS syndrome but difficult to verify as a culprit drug, since antitubercular agents are coadministered as a combination regimen. A 42-year-old female with endobronchial tuberculosis was diagnosed with DRESS syndrome after 4-week treatment of isoniazid, rifampicin, ethambutol, and pyrazinamide with prednisolone 50 mg. All the antitubercular agents were stopped and replaced with levofloxacin, cycloserine, p-aminosalicylic acid, and kanamycin. However, severe exacerbation of DRESS syndrome compelled the patient to discontinue the administration of the second-line antitubercular agents. Two months later, the patient underwent a patch test for all the antitubercular agents which had been used, and the results showed positivity to isoniazid and cycloserine. We report a rare case of DRESS syndrome that reacted to cycloserine as well as isoniazid. Development of coreactivity to other drugs should be differentiated with a flare-up reaction in the management of DRESS syndrome. (Allergy Asthma Respir Dis 2017:5:111-116)