69 Severe Cutaneus Drug Reactions: Description of a Serie Cases

Objective To describe the cases of severe cutaneus drug reactions reported in patients admitted to a hospital in São Paulo, assisted by the Service of Allergy and Immunology. Methods A case serie study based on record's analysis of patients who were hospitalized from January 2002 to June 2011 evaluated by the allergist. Results We evaluated 25 cases of severe drug reactions, among which 13 (52%) were Drug Rash with Eosinophilia and Systemic Symptoms (DRESS), 7 (29.4%) Stevens-Johnson syndrome (SJS), 4 (16) Toxic Epidermal Necrolysis (TEN) and 1 (4%) Acute Generalized Exanthematous Pustulosis (PEGA). The patients' ages ranged from 5 to 77 years (median = 37), 13 (52%) were male. The drug classes more closely related were antibiotics 18 (45%), non-steroidal anti-inflammatory 12 (30%) and anticonvulsants 9 (25%). The mean length of hospital stay was 15 days. Systemic involvement occurred in 15 (60%) patients, of whom 15 (100%) liver involvement, 5 (33%) kidney, 2 (13%) pancreatic and 1 (6%) thyroid. There was mucosal involvement in 12 (80%) cases. Three patients (12%) had septicemia, which led to mortality. All of them had TEN with extensive cutaneus involvement. Other patients presented sequelae in the skin (4–16%) and in the eyes (5–20%). Other complications observed were: cholestatic syndrome, immunodeficiency and autoimunidade, each of them in one patient. Conclusion In this serie of cases, DRESS was the most frequent disease and antibiotics were the drugs most commonly implicated. The average hospital stay was prolonged. Liver involvement was the main systemic commitment. TEN was responsible for the major mortality rate.