Liver injury in patients with DRESS: A clinical study of 72 cases.

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a syndrome involving multiple systems. Liver injury is the most common visceral manifestation. The purpose of this study was to investigate the types of liver injury and factors associated with DRESS. A retrospective cohort study was conducted in Taiwan using a DRESS database compiled from December 2000 to March 2013. Seventy-two cases were included in this study. Among them, 62 (86.1%) cases involved liver injury, 6 of which (9.7%) were liver injury before skin presentation. The distribution of liver injury patterns at initial presentation was 23 cholestatic type (37.1%), 17 mixed type (27.4%), and 12 hepatocellular type (19.4%). Patients with hepatocellular-type injuries were younger, with a median age of 31.5 (P = .044). Individuals with liver function results more than 10 times the upper limit were more likely to have fever (P = .026), took more time to recover, and had fewer eosinophils in the dermis (P = .002). The study was a retrospective cohort study with limited cases. Liver injury is common in DRESS and frequently associated with atypical lymphocytosis. The cholestatic type is the most common type. Patients with cholestatic-type injuries were older and more frequently had interface changes in skin pathology.