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Abstract: TH-PO169

DRESS to Impress: Unusual Case of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) due to Epoetin Alfa

Session Information

Category: Trainee Case Report

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Santos Roman, Yelixa, Veterans Affairs Caribbean Healthcare system, Coto Laurel, Puerto Rico, United States
  • Cortes, Carlos, Veterans Affairs Caribbean Healthcare system, Coto Laurel, Puerto Rico, United States
Introduction

DRESS syndrome is a severe life-threatening hypersensitivity reaction to medication or its active metabolites. It manifests with fever, rash & organ involvement, kidneys & liver most commonly. It has a 10% mortality rate. More frequently associated with DRESS are sulfonamides, anti-inflammatory medications & anticonvulsants. There is only one case report of epoetin alfa related DRESS syndrome in the literature, and herein we present the second.

Case Description

92 y/o man with hypertension, A. fib. & CKD IIIa arrived at ED due to generalized pruritic skin eruption since 7 days ago. Physical exam: generalized non-blanching erythematous patches on lower extremities, torso & upper extremities. Few violaceous purpuric patches on extremities, petechias on palms & feet. Labs: WBC: 17.9 x10^3/UL, Plt: 270 10^3/UL, Eosinophils: 895. BUN: 50.7 mg/dL & Cr.: 1.8 mg/dl (base:1.2), ALT: 39, AST: 23 & CRP: 127.3. He was started on epoetin alfa 8 days prior, which was discontinued upon admission. Dermatology biopsied a lesion & recommended methylprednisolone (MP) IV for 2 days. Rash, eosinophils & creatinine improved. MP was discontinued as per derm. recc. but rash, eosinophils & creatinine again worsened. Biopsy: spongiotic dermatitis w/parakeratosis, pustules in stratum corneum, dermal perivascular lymphocytic infiltrate & scanty eosinophils. Allergist recc. restart MP for epoetin alfa related DRESS. See Fig 1 for data on MP, creatinine & eosinophils. He improved & was discharged on a steroid tapering

Discussion

The European Registry of severe cutaneous adverse reactions is a scoring system to help yield the diagnosis of DRESS, a score of 6 makes it definitive, as presented in this case. Only ~11% of patients with DRESS manifest with renal disease. After literature review, this is only the second case of epoetin alfa associated DRESS. Epoetin alfa is a commonly used drug in patients with CKD & physicians should be aware of this potentially fatal adverse effect.

Changes in eosinophilia and creatinine with methylprednisolone dose