DRESS (drug reaction with eosinophilia and systemic symptoms): a synergy between drug and virus leading to the intensive care unit

Abstract

Drug-induced hypersensitivity syndrome or DRESS (drug reaction with eosinophilia and systemic symptoms) is a severe drug-induced reaction. Its features include high fever, rash, facial oedema, lymphadenopathies, eosinophilia, and atypical lymphocytes. Its severity is due to the development of visceral manifestations (hepatitis, hemophagocytic syndrome, encephalitis, pneumonitis, renal failure, pancreatitis, and thyroiditis) and may lead to multiple organ failure and a transfer to the intensive care unit. This syndrome has some specificities among the cutaneous adverse drug reaction. DRESS is the consequence of an immune response directed against viral reactivations (Human Herpesviurs 6, Human Herpesvirus 7, Epstein-Barr virus, cytomegalovirus). These viral reactivations are induced by a few drugs. DRESS should be considered as a viral disease in which some drugs stimulate viral reactivations in a genetically predisposed background. DRESS is a model to study a medical area that is still unrecognized: the link between drugs and viruses.