Successful treatment of a case of recurrent drug reaction syndrome with a combination of cyclosporine and glucocorticoids

Abstract

A case of recurrent drug reaction with eosinophilia and systemic symptoms successfully treated with cyclosporine combined with glucocorticoids is reported. A 36-year-old female presented with an one-month history of recurrent, itchy erythemas and papules covering her entire body. Dermatological examination revealed a swollen face, and millet-sized macules and papules all over the body. Enlarged lymph nodes were palpated bilaterally behind the ears, on the sides of the neck, in the axillae, and in the inguinal areas. The results of laboratory tests at admission were as the follows: leukocyte count, 11.36×109/L; absolute eosinophil count (EO), 0.66×109/L; glutamic oxaloacetic transaminase, 181 U/L; glutamic pyruvic transaminase, 370 U/L; IgE count, 21 500 IU/mL; positive for both HHV-6-DNA and CMV-DNA, and an EBV-DNA count, 1.00×105 copies/mL. The diagnosis was drug reaction with eosinophilia and systemic symptoms (DRESS). The patient was treated with cyclosporin A and glucocorticoids, supplemented with antiviral therapy. The patient's generalized rashes gradually subsided after the treatment, leaving a few hyperpigmented spots. The patient was followed up for more than 3 months without recurrence.

Keywords

• drug reaction with eosinophilia and systemic symptoms
• cyclosporine
• drug-specific t-cells