A Survey On Drug Reactions in Latin America

M O N D A Y 609 DRESS Syndrome Induced by Piperacillin-Tazobactam in Eight Patients Oscar Calder on, Ana Fiandor, Teresa Caballero, MD, PhD, Teresa Bell on, Nieves Prior Gomez, MD, M. C. Lopez-serrano, Santiago Quirce, MD, PhD, Rosario Caba~nas; La Paz University Hospital, Hospital La Paz, Hospital La Paz Research Center (IdiPaz), Madrid, Spain, La Paz University Hospital, ME, Spain, Hospital Universitario La Paz, Madrid, Spain, La Paz University Hospital, Spain, Hospital La Paz Institute for Health Research, Dept. of Allergy, Madrid, Spain. RATIONALE: DRESS syndrome, is a life-threatening multiorganic systemic reaction characterized by rash, fever, lymphadenopathy, hepatitis, and leukocytosis with eosinophilia. Our objective is to describe the clinical and laboratory findings of eight DRESS syndrome cases induced by piperacillin-tazobactam studied in our allergy clinic from 2006 to 2012. METHODS: A descriptive study using the patients’ clinical charts was perfomed. The DRESS syndrome diagnosis was established according RegiSCAR criteria (Kardaun scale criteria). An allergological workup including prick test, intradermal test, patch test and Lymphocyte Transformation Test (LTT) according to Pitchler et al. RESULTS: A cohort of three women and five men had a median age of 60.5 years. Skin rash had a mean latency time of 18 days, maculopapular pruriginous generalized exanthema was detected in all cases and facial edema in 50%. Fever was present in seven patients and lymphadenopathies in four. All had eosinophilia greater than 1000/mm, three had leukocytosis, two had atypical lymphocytes. Further analyses revealed hepatic cytolysis in five patients. HHV-6 reactivation was present in two out of six patients. LTT was positive in all the patients with SI > 4. All of them had a full recovery. CONCLUSIONS: Piperacillin-tazobactam was shown to be the most frequent culprit drug in our group of patients with DRESS syndrome and it should be included on the list of drugs that cause DRESS. Skin rash, facial angioedema, fever, eosinophilia, and liver abnormalities are features of piperacilin-tazobactam DRESS syndrome. An allergological study including LTTwas proved useful in identifying the drug involved in the reaction.