Prevalence and Clinical Features of Drug Reactions With Eosinophilia and Systemic Symptoms Syndrome Caused by Antituberculosis Drugs: A Retrospective Cohort Study

다국어 초록 (Multilingual Abstract)

Purpose: Although there have been reported cases of drug reactions with eosinophilia and systemic symptoms (DRESS) syndrome caused by antituberculosis drugs, there has been no research to examine its prevalence. This study assessed the prevalence and clinical characteristics of DRESS syndrome caused by antituberculosis drugs.
Methods: The electronic medical records of a cohort consisting of adult patients diagnosed with tuberculosis between July 2006 and June 2010 were reviewed and retrospectively inspected. We searched the surveillance system for adverse drug reactions and the electronic medical records to identify patients who reported severe cutaneous adverse reactions to antituberculosis drugs. These patients were then re-assessed using a European Registry of Severe Cutaneous Adverse Reactions to Drugs and Collection of Biological Samples (RegiSCAR) scoring system. Clinical characteristics, including the symptoms and latency of DRESS syndrome, the therapeutic dosage and period of steroids, and the final duration of tuberculosis therapy, were examined.
Results: Of the 1,253 adult patients with tuberculosis receiving antituberculosis drugs, 15 were identified as potential cases of DRESS syndrome (prevalence of 1.2%). Ethambutol was the most frequently used drug (53.5%), followed by rifampicin (26.7%), pyrazinamide (20.0%), streptomycin (13.3%), and isoniazid (6.7%). The median latency after day 1 of antituberculosis medication was 42 days. The median daily dose of steroids, expressed in prednisone-equivalent units, was 33-mg/day, and the median dosing period was 14 days. The duration of tuberculosis treatment was 76 days longer than the standard treatment period of 180 days. There was a significant difference in the peak eosinophil counts of DRESS syndrome patients according to RegiSCAR scores. Moreover, there was a significant quantitative correlation between the RegiSCAR score and peak eosinophil count. A negative correlation was also found between the RegiSCAR score and latency.
Conclusions: This study confirmed the prevalence of DRESS syndrome in a cohort of adult patients with tuberculosis.

참고문헌 (Reference)

1 Kardaun SH, "Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms : does a DRESS syndrome really exist" 156 : 609-611, 2007

2 Orenstein EW, "Treatment outcomes among patients with multidrug-resistant tuberculosis : systematic review and meta-analysis" 9 : 153-161, 2009

3 Garcia-Doval I, "Toxic epidermal necrolysis and Stevens-Johnson syndrome : does early withdrawal of causative drugs decrease the risk of death" 136 : 323-327, 2000

4 박흥우, "The Fas Signaling Pathway Is a Common Genetic Risk Factor for Severe Cutaneous Drug Adverse Reactions Across Diverse Drugs" 대한천식알레르기학회 10 (10): 555-561, 2018

5 Cacoub P, "The DRESS syndrome : a literature review" 124 : 588-597, 2011

6 Shebe K, "Severe recurrence of drug rash with eosinophilia and systemic symptoms syndrome secondary to rifampicin patch testing in a human immunodeficiency virus-infected man" 70 : 125-127, 2014

7 Schaberg T, "Risk factors for side-effects of isoniazid, rifampin and pyrazinamide in patients hospitalized for pulmonary tuberculosis" 9 : 2026-2030, 1996

8 Elzagallaai AA, "Patch testing for the diagnosis of anticonvulsant hypersensitivity syndrome : a systematic review" 32 : 391-408, 2009

9 Zhang SN, "Isoniazid-induced drug rash with eosinophilia and systemic symptoms(DRESS)syndrome presenting as acute eosinophilic myocarditis" 54 : 1227-1230, 2015

10 Gentile I, "Is the drug-induced hypersensitivity syndrome(DIHS)due to human herpesvirus 6 infection or to allergy-mediated viral reactivation? Report of a case and literature review" 10 : 49-, 2010

11 Yee D, "Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis" 167 : 1472-1477, 2003

12 Barbaud A, "Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions. Proposed by the Working party of the ESCD for the study of skin testing in investigating cutaneous adverse drug reactions" 45 : 321-328, 2001

13 Karlin E, "Genotyping for severe drug hypersensitivity" 14 : 418-, 2014

14 Bocquet H, "Drug-induced pseudolymphoma and drug hypersensitivity syndrome(drug rash with eosinophilia and systemic symptoms : DRESS)" 15 : 250-257, 1996

15 Yoshioka Y, "Drug-induced hypersensitivity syndrome by ethambutol : a case report" 43 : 971-972, 2016

16 Kardaun SH, "Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study" 169 : 1071-1080, 2013

17 정을식, "Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Induced by Ethambutol and Rifampin" 대한감염학회 44 (44): 197-200, 2012

18 Joo Ho Lee, "Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Induced by Celecoxib and Anti-tuberculosis Drugs" 대한의학회 23 (23): 521-525, 2008

19 Hirahara K, "Differences in immunological alterations and underlying viral infections in two well-defined severe drug eruptions" 35 : 863-868, 2010

20 Husain Z, "DRESS syndrome: part I. Clinical perspectives" 68 : 639.e1-639.e14, 2013

21 Kim H, "DRESS syndrome and acute generalized exanthematous pustulosis induced by antituberculosis medications and moxifloxacin : case report" 54 : 808-815, 2016

22 Lehloenya RJ, "Cutaneous adverse drug reactions to anti-tuberculosis drugs : state of the art and into the future" 10 : 475-486, 2012

23 Ogawa K, "Case of drug-induced hypersensitivity syndrome involving multiple-drug hypersensitivity" 39 : 945-946, 2012

24 Kim SH, "Antituberculosis drug-induced hypersensitivity syndrome and its association with human leukocyte antigen" 93 : 270-274, 2013

25 Lee SW, "Antituberculosis drug-induced drug rash with eosinophilia and systemic symptoms syndrome confirmed by patch testing" 20 : 631-632, 2010

26 Allouchery M, "Antituberculosis drug-associated DRESS : a case series" 6 : 1373-1380, 2018

27 Blumberg HM, "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America : treatment of tuberculosis" 167 : 603-662, 2003

28 Breen RA, "Adverse events and treatment interruption in tuberculosis patients with and without HIV co-infection" 61 : 791-794, 2006

29 Edwards IR, "Adverse drug reactions : definitions, diagnosis, and management" 356 : 1255-1259, 2000

30 이진영, "A Case of the Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) Following Isoniazid Treatment" 대한결핵및호흡기학회 78 (78): 27-30, 2015