Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome secondary to antimicrobial therapy in pediatric bone and joint infections

Sema Yildirim Arslan, MD; Zumrut Sahbudak Bal, MD; Gizem Guner Ozenen, MD; Nimet Melis Bilen, MD; Gulhadiye Avcu, MD; Ece Erci, MD; Zafer Kurugol, MD; Huseyin Gunay, MD; İpek Tamsel, MD; Ferda Ozkinay, MD

World Allergy Organization Journal (Feb 2024)

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome secondary to antimicrobial therapy in pediatric bone and joint infections

Sema Yildirim Arslan, MD,
Zumrut Sahbudak Bal, MD,
Gizem Guner Ozenen, MD,
Nimet Melis Bilen, MD,
Gulhadiye Avcu, MD,
Ece Erci, MD,
Zafer Kurugol, MD,
Huseyin Gunay, MD,
İpek Tamsel, MD,
Ferda Ozkinay, MD

Affiliations

Sema Yildirim Arslan, MD: Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
Zumrut Sahbudak Bal, MD: Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey; Corresponding author. Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Turkey.
Gizem Guner Ozenen, MD: Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
Nimet Melis Bilen, MD: Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
Gulhadiye Avcu, MD: Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
Ece Erci, MD: Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
Zafer Kurugol, MD: Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey
Huseyin Gunay, MD: Medical School of Ege University, Department of Orthopaedics and Traumatology, Izmir, Turkey
İpek Tamsel, MD: Medical School of Ege University, Department of Radiology, Izmir, Turkey
Ferda Ozkinay, MD: Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey

Journal volume & issue: Vol. 17, no. 2
p. 100850

Abstract

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Background: Bone and joint infections are common in children, particularly those under 10 years of age. While antimicrobial therapy can often successfully treat these infections, surgical drainage may also be necessary. It is important to note that prolonged courses of treatment have been associated with adverse events and drug reactions. Among these, drug reactions with eosinophilia and systemic symptoms (DRESS) syndrome is particularly severe and potentially life-threatening. We aimed to evaluate the cases of DRESS syndrome that develop during the treatment of bone and joint infections. Methods: A retrospective study was conducted at a tertiary-level university hospital between 2015 and 2022 to determine the incidence and outcomes of definite DRESS Syndrome in children under 18 years of age with bone and joint infections. Results: Of 73 patients with bone and joint infections, 16 (21.9 %) children developed antimicrobial therapy-induced DRESS syndrome. Eight (50 %) of these children were boys; the mean age of the patients was 9.76 ± 5.5 years. DRESS syndrome occurred in 16 children, including 13 children with osteomyelitis, 1 child with osteomyelitis and septic arthritis, and 2 children with septic arthritis and sacroiliitis. The mean duration of intravenous antibiotic therapy was 40.6 ± 16.6 days; the mean hospital stay was 48.7 ± 23.7 days; the mean time for the development of DRESS syndrome after starting antibiotics was 19.6 ± 7.68 days. New onset fever (68.8 %) and rash (43.8 %) were the most common symptoms of DRESS Syndrome. Cefotaxime and vancomycin were drugs responsible for DRESS syndrome in 8 (50 %) of 16. The causative antibiotics were switched to another class of antibiotic, most commonly preferred was ciprofloxacin (n:5; 31.3 %). For children with persistent symptoms, steroids were used in 5 (31.25) patients. Conclusions: Clinicians should be aware of DRESS syndrome in children who develop fever and rash under long-term antibiotics and should check hematological and biochemical parameters to predict the severity of DRESS syndrome. In patients with persistent symptoms, steroids may be used to control the symptoms.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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