Drug rash with eosinophilia and systemic symptoms syndrome: A prospective study at a tertiary health-care center

Abstract

Abstract Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can be fatal if there is delay in diagnosis and discontinuation of causative drug. It is commonly linked with anticonvulsants and antibiotics. Understanding typical ocular manifestations can aid in early diagnosis and treatment. The main aim of this study is to provide an overview of common ocular manifestations of DRESS syndrome along with identifying the medications responsible and determining age and gender predilection. Methods: This is a 2-year observational study from June 2018 to June 2020. 37 patients recruited from ophthalmology OPD were thoroughly examined, and diagnosed in consultation with the microbiology and dermatology departments. Data required were collected by systematic examination of medical records. Patients diagnosed with DRESS syndrome having redness, itching, watering of eyes, diminision of vision, lid swelling, discharge, pain, and foreign body sensation were included in the study. Patients with no drug history, immediate drug hypersensitivity reactions, steven- Johnson syndrome were excluded. Results: Common ocular manifestations observed were tarsitis (14%), madarosis (12%), ulcerative blepharitis (10%) and conjunctivitis (10%), squamous blepharitis and keratoconjunctivitis (9%) along with other rare findings. Common triggering drugs were anti tubercular treatment (46%), carbamazepine (24%), dapsone (5%), antibiotics (11%). Mean age group affected was 42.05 years with peak between 11-20 years and slight female preponderance of 54%, with males being 46%. Conclusion: Knowing common ocular manifestations of DRESS syndrome and the drugs triggering is crucial in preventing serious consequences. Though treatment is supportive and steroids, key is to withdraw the causative drug early.