Viral reactivation and outcomes in drug reaction with eosinophilia and
systemic symptoms (DRESS)
Abstract
Abstract Background Drug reaction with eosinophilia and systemic
symptoms (DRESS) is a severe cutaneous adverse drug reaction associated
with human herpesvirus reactivation. However, the risk factors for viral
reactivation and their impact on outcomes remain unclear.We aimed to
explore the impact of viral reactivation on DRESS outcomes and potential
risk factors for reactivation. Methods This was a retrospective cohort
study in an academic medical center. Cases were validated in-hospital
cases of DRESS from 2009 to 2017. Results Overall, 100 patients
fulfilled the case criteria. Ninety-three patients had at least one
viral marker tested. HHV6, EBV and CMV reactivation occurred in 24 out
of 85 cases (28%), 15 out of 87 (17%) cases, and 18 out of 89 (20%)
cases respectively. Viral reactivation cases were associated with higher
1-year mortality, dialysis initiation, recurrent flares of disease, and
longer hospital stay (all p<0.05). Risk of inpatient mortality
(OR, 5.8; 95% CI, 1.7-20.7; p<0.01) and 1-year mortality (OR,
10.0, 95% CI, 2.9-34.9; p<0.01) increased with multiple viral
reactivations. Viral reactivation was independent of demographics,
comorbidities, treatment or causative drug. Conclusion Human
herpesviridae viral reactivation in DRESS, particularly multiple viral
reactivations, is associated with poorer clinical outcomes.