Table 2 Clinical characteristics of patients enrolled in the study
Age at Diagnosis, years | Gender (M/F) | Implicated drug | Diagnosis | Time from first dose to onset of first symptom, days | Time from first dose to onset of rash, days | Clinical characteristics | Skin biopsy result | Treatment | Time to resolution after treatment commenced, days | |
|---|---|---|---|---|---|---|---|---|---|---|
P1 | 42 | F | Vancomycin | DRESS | 11 | 12 | Fever Eosinophilia 2.1 × 109/L Lymphocytosis 6.0 × 109/L Rash > 50% BSA Hepatitis | Variable epidermal spongiosis Superficial dermal perivascular lymphohistiocytic infiltrate with scattered perivascular eosinophils | Ceased implicated drug Corticosteroids IVIG | 22 |
P2 | 77 | M | Piperacillin/ Tazobactam (Tazocin) | DRESS | 25 | 25 | Fever Eosinophilia 1.0 × 109/L Rash > 50% BSA Hepatitis | Lichenoid inflammation in epidermis Mild perivascular lymphocytic infiltrate with occasional eosinophils in dermis | Ceased implicated drug Corticosteroids | 21 |
P3 | 21 | F | Sulfasalazine | DRESS | 26 | 26 | Fever Lymphadenopathy – cervical and inguinal Eosinophilia 3.3 × 109/L Lymphocytosis 9.0 × 109/L Rash > 50% BSA Hepatitis | Lichenoid inflammation in epidermis Lymphohistiocytic infiltrate in dermis is predominantly perivascular but also at dermatoepidermal junction with isolated eosinophil | Ceased implicated drug Corticosteroids | 36 |
P4 | 43 | F | Allopurinol | DRESS | 17 | 25 | Fever Eosinophilia 2.7 × 109/L Lymphocytosis 4.2 × 109/L Rash > 50% BSA Hepatitis | Mild to moderate infiltrate in dermis predominantly perivascular with lymphocytes and eosinophils | Ceased implicated drug Corticosteroids | 20 |
P5 | 18 | M | Sulfasalazine | DRESS | 35 | 37 | Fever Lymphadenopathy —occipital, cervical, axillary, inguinal Eosinophilia, value unavailable Rash > 50% BSA Hepatitis | Not performed | Ceased implicated drug Corticosteroids | 60 |
P6 | 54 | F | Apixaban | AGEP | 1 | 1 | Fever Neutrophilia 13.9 × 109/L Pustular rash | Not performed | Cease implicated drug Topical corticosteroids | 7 |
P7 | 53 | M | Tazocin | DRESS | 28 | 28 | Fever Eosinophilia 6.5 × 109/L Rash > 50% BSA Hepatitis | Epidermis—mild spongiosis with foci of lymphocyte exocytosis Superficial dermis—perivascular lymphocytes and histiocytes, and occasional eosinophils | Cease implicated drug Corticosteroids IVIG | 20 |
P8 | F | Amoxicillin + clavulanic acid | DRESS | Rash > 50% BSA Hepatitis Acute kidney injury | Epidermis—mild spongiosis Prominent papillary dermal oedema, dermal perivascular and interstitial infiltrate with lymphocytes, histiocytes and occasional eosinophils, neutrophils and plasma cells | Cease implicated drug Corticosteroids | 10 | |||
P9 | 62 | F | Lenalidomide | DRESS | 28 | 28 | Fever Eosinophilia 5.0 × 109/L Rash > 50% BSA Conjunctivitis Hepatitis Acute kidney injury | Epidermis—mild spongiosis with foci of lymphocyte exocytosis Dermis—patchy perivascular lymphocytic infiltrate with occasional eosinophils | Cease implicated drug Corticosteroids | 17 |
P10 | 66 | M | Benzylpenicillin | AGEP | 1 | 1 | Pustular rash Neutrophilia 27 × 109/L | Epidermis—spongiosis, psoriasiform hyperplasia and scattered intraepithelial lymphocytes, small subcorneal pustules, and spongiotic vesicles with degenerating inflammatory cells Dermis—markedly oedematous, prominent perivascular inflammatory infiltrate with lymphocytes and histiocytes, scattered eosinophils and rare neutrophils in interstitium | Cease implicated drug Corticosteroids | 14 |