Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The group of severe cutaneous drug reactions with systemic symptoms includes several syndromes: toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms (DRESS). These reactions occur several days to six weeks after introducing the incriminating drug. The skin and internal organs (liver, kidneys, lungs, etc.) are usually involved. A great possibility of lethal outcome is a critical characteristic of these syndromes. A patient with pyelonephritis diagnosed during emergency room workup is described. Ciprofloxacin was prescribed and the patient was discharged. After ten days, the patient came back with worsening condition, general inflammatory response, skin changes, liver and kidney damage, and eosinophilia. DRESS syndrome was diagnosed based on clinical and other findings. The diagnosis and treatment of severe drug reactions with cutaneous and systemic symptoms pose a medical challenge.Teške oblike kožnih reakcija na lijekove povezanih sa sistemskim simptomima čini nekoliko sindroma: toksična epidermalna nekroliza, Stevens-Johnsonov sindrom, akutna generalizirana egzantematozna pustuloza te reakcija na lijekove s eozinofilijom i sistemskom reakcijom (DRESS). Kod takvih reakcija se nekoliko dana do 6 tjedana od uvođenja lijeka pojave promjene na koži, a često su zahvaćeni i unutarnji organi (jetra, bubrezi, pluća i dr.). Zbog toga je u ovakvim oblicima preosjetljivosti na lijekove velika smrtnost. Opisuje se slučaj bolesnice kojoj je ambulantno dijagnosticiran pijelonefritis, te je bila otpuštena kući uz preporuku terapije ciprofloksacinom. Deset dana kasnije bolesnica se vratila u ambulantu s pogoršanjem kliničke slike, lošeg općeg stanja, uz pojavu kožnih eflorescencija, oštećenje jetrene i bubrežne funkcije te s eozinofilijom. Na temelju kliničkih nalaza i ostale obrade postavljena je dijagnoza sindroma DRESS. Dijagnoza i terapija teških oblika reakcija na lijekove i u današnje vrijeme predstavljaju medicinski izazov
