MANAGING DRESS TRIGGERRED BY CUTAENOUS AMOXICILLIN ADMINISTRATION.pptx

This presentation is about the case report on drug reaction with eosinophilia and systemic symptoms.

1. MANAGING DRESS TRIGGERED BY CUTANEOUS AMOXICILLIN ADMINISTRATION: A CASE REPORT TEMIE PAUL B. VILLARINO, MD SECOND YEAR IM RESIDENT ZAMBOANGA CITY MEDICAL CENTER OCTOBER 20, 2025 DEPARTMENT OF INTERNAL MEDICINE ZAMBOANGA CITY MEDICAL CENTER

2. P 66 YO FEMALE MARRIED ROMAN CATHOLIC CHIEF COMPLAINT: MORBILLIFORM RASH PATIENT PROFILE

3. OBJECTIVES DETERMINE THE TEMPORAL PROFILE OF A PATIENT WITH DRESS DISCUSS THE TREATMENT APPROACH TO PATIENTS WITH DRESS REVIEW THE PROGNOSIS AND LONG TERM GOALS IN PATIENTS WITH DRESS

4. PATIENT HISTORY BULLAE FORMATION ON LEFT HEEL -APPLIED AMOXICLLIN -GENERALIZED PRURITIC RASH ON EXTREMITIES -NOTED WITH FEVER, PRODUCTIVE COUGH -BROUGHT TO A LOCAL HOSPITAL -NOTED WORSENING OF SYMPTOMS WHILE ADMITTED 2 WEEKS 4 DAYS 3 DAYS

5. PhYSICAL EXAMINATION General Survey Alert, oriented to 3 spheres In respiratory distress BP 100/60 Temp 37.6 HR 89 RR 28 O2sat 95% at room air Wt : 70 kg Ht 160 cm BMI: 27.3 (Obese I) Dry, Generalized morbilliform rash with exfoliations and excoriations HEENT Icteric Sclerae, Pale conjunctivae, absent eyelashes, dry and cracked lips cervical lymphadenopathy CHEST AND LUNGS Tachypneic, diffuse crackles HEART AND GIT Unremarkable EXTREMITIES EDEMA GRADE II Inguinal lymphadenopathy

6. SALIENT FEATURES FEMALE NON-REPRODUCTIVE AGE EXPOSURE TO AMOXICILLLIN MORBILLIFORM RASH FEVER COUGH ICTERESIA EDEMA

7. Lab work up Hgb 79 Hct 0.24 MCV 89.8 MCH 29.7 WBC 24.8 N 70 L 11 E 11 AEC 2, 728 Plt 213 CBG 169 BUN 28 Crea 519 CrCl 8 Na 125 K 3.0 Mg 0.6 ALT 188 AST 81 FANA NEGATIVE HBsAg NON REACTIVE ANTI-HCV NON REACTIVE BLOOD CULTURES NO GROWTH

8. DISCUSSION RegiSCAR DIAGNOSIS SCORE FOR DRESS

9. Management of dress Sta rted on Hydrocortione T apered off to Prednisone Suppor tive Management -Antibacterial -Antihistamine -Antipyretics

10. Follow up and prognosis INCREASED RISK FOR AUTOIMMUNE DISORDERS INCLUDING AUTOIMMUNE THYROIDITIS, SLE AND DIABETES MELLITUS

11. CONCLUSION SELF-MEDICATION is still prevalent among Filipinos especially those living in the rural areas where access too health services is limited. When it occurs, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome requires early recognition and prompt management to prevent fatal outcomes. Prevention remains the cornerstone in reducing hypersensitivity events, emphasizing the importance of educating the public against self-medication. What sometimes feels GOOD as is not always RIGHT.

12. References: Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 3rd ed. Philadelphia: Elsevier Saunders; 2012. James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Andrew’s Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia: Elsevier; 2019. Fitzpatrick TB, Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York: McGraw-Hill Medical; 2008. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison’s Principles of Internal Medicine. 21st ed. New York: McGraw-Hill Education; 2022. Adkinson NF, Bochner BS, Burks AW, Holgate ST, Lemanske RF Jr, O’Hehir RE. Middleton’s Allergy: Principles and Practice. 9th ed. Philadelphia: Elsevier; 2020. Calle A, Aguirre N, Ardila J, Villa R. DRESS syndrome: a literature review and treatment algorithm. World Allergy Organ J. 2023;16(3). Scrace B, Fityam A, Bigham C. Drug reaction with eosinophilia and systemic symptom. Br J Anaesth . 2020;20(2):65–71. Cho Y, Yang C, Chu C. Drug reaction with eosinophilia and systemic symptoms: an interplay among drugs, viruses and immune system. Int J Mol Sci. 2017;18:1243. 1. Shiohara , T., & Iwatsuki , K. (2004). Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS): Pathophysiology and management. The Journal of Dermatology, 31(6), 349-359. doi:10.1111/j.1346-8138.2004.tb00641.x Batawi, S., & Padhy , S. K. (2017). Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: A review of the literature. Indian Journal of Pharmacology, 49(1), 13-18. doi:10.4103/0253-7613.199040