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Sustained Drug-related Reaction With Eosinophilia and Systemic Symptoms (DRESS) Triggered by Low Molecular Weight Heparins in COVID-19: Management and Precision Diagnosis

Authors :
Maria Filomena Caiaffa
Maria Pia Foschino Barbaro
Lucia Anna Giliberti
Eustachio Nettis
Danilo Di Bona
Marcello Albanesi
Maria Pia Rossi
Nada Chaoul
Luigi Macchia
Elena Minenna
Publication Year :
2021
Publisher :
Research Square Platform LLC, 2021.

Abstract

Background. Low molecular weight heparins (LMWHs) are administered routinely to COVID-19 patients. Systemic reactions to LMWHs (both IgE-mediated and non IgE-mediated) are considered rare. Particularly, a single case of drug-related reaction with eosinophilia and systemic symptoms (DRESS) due to enoxaparin has been described in the literature. Here, we report on the first case of DRESS related to administration of fondaparinux.Case presentation. An elderly woman was diagnosed with COVID-19, during the “first wave” of the pandemics in Italy, and treated with enoxaparin (for anti-coagulation). A DRESS syndrome developed after two weeks (RegiSCAR score = 7). Enoxaparin was considered the culprit drug and replaced with the fully synthetic LMWH fondaparinux. At the same time, high-dosage prednisone was added to the therapy. The DRESS slowly subsided and the patient survived. Upon recovery and corticosteroid washout, a lymphocyte proliferation test for both LMWHs was performed, yielding a positive response not only for enoxaparin but also for fondaparinux. Conclusions. By lymphocyte proliferation test we demonstrated that both enoxaparin and fondaparinux were implicated in this case of DRESS, occurring in an elderly COVID-19 patient. In retrospect, the choice of using a sustained high-dose corticosteroid treatment while maintaining anti-coagulation by fondaparinux proved to be right. Ultimately, the patient recovered from both DRESS and COVID-19.

Details

Database :
OpenAIRE
Accession number :
edsair.doi.dedup.....a273187be6e31bc37a228f47c7ea4c13
Full Text :
https://doi.org/10.21203/rs.3.rs-439675/v1