DRESS syndrome

Joint Bone Spine. 2014 Jan;81(1):15-21. doi: 10.1016/j.jbspin.2013.05.002. Epub 2013 Jun 29.


Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, initially recognized as a serious form of cutaneous drug adverse reaction, is now viewed as a drug-related syndrome that can cause life-threatening organ dysfunctions. Characteristic features include a long time interval from first drug exposure to symptom onset and a prolonged course, often with flares, even after discontinuation of the causal drug. The pathophysiology of DRESS syndrome remains incompletely understood but involves reactivation of herpes viruses (HHV-6, HHV-7, EBV, and CMV), against which the body mounts a strong immune response. The culprit drugs may not only affect epigenetic control mechanisms, thereby promoting viral reactivation, but also induce an antiviral T-cell response by interacting with the major histocompatibility complex receptor in individuals with genetic susceptibility factors. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a potentially life-threatening form of cutaneous drug adverse reaction. The severity of this syndrome is related to the systemic manifestations, which can result in multiorgan failure. DRESS syndrome is characterized by highly specific features, most notably regarding the timing of the manifestations. New insights into the underlying pathophysiological mechanisms indicate a role for immunogenetic susceptibility factors and for reactivation of human herpes viruses (HHVs), chiefly HHV-6. We report a typical case of DRESS syndrome and discuss recent data about this condition.

Keywords: Cytomegalovirus; DIHS; DRESS; Epstein-Barr virus; HLA; Human Herpesvirus 6; Hypersensitivity; Toxic dermatitis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Drug Hypersensitivity Syndrome / diagnosis*
  • Drug Hypersensitivity Syndrome / etiology
  • Drug Hypersensitivity Syndrome / therapy
  • Drug Hypersensitivity Syndrome / virology
  • Humans
  • Male
  • Middle Aged