Síndrome DRESS asociado al uso de fenitoína en paciente pediátrico con epilepsia: reporte de caso clínico y revisión narrativa
DOI:
https://doi.org/10.5281/zenodo.20844483Palabras clave:
síndrome DRESS, fenitoína, farmacodermia, epilepsia, pediatría, eosinofilia, reacción cutánea adversa grave, DRESS syndrome, phenytoin, drug eruption, epilepsy, pediatrics, eosinophilia, severe cutaneous adverse reaction, Síndrome DRESS, reação cutânea adversa graveResumen
El síndrome DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) es una reacción adversa medicamentosa grave caracterizada por exantema extenso, fiebre, eosinofilia y compromiso sistémico variable. El objetivo de este estudio fue analizar un caso clínico compatible con síndrome DRESS asociado al uso de fenitoína en un paciente pediátrico con epilepsia, describiendo su evolución clínica, criterios diagnósticos, diagnósticos diferenciales y manejo terapéutico. Se desarrolló un estudio cualitativo, descriptivo y clínico-documental basado en la revisión de una historia clínica anonimizada, exámenes complementarios, valoraciones multidisciplinarias y registro fotográfico. Los hallazgos principales incluyeron exantema maculopapular generalizado, fiebre persistente, edema facial, prurito, eosinofilia moderada y sospecha de compromiso pulmonar, con ausencia inicial de afectación hepática o renal significativa. La aplicación de los criterios RegiSCAR apoyó el diagnóstico probable a definitivo de síndrome DRESS. El tratamiento consistió en la suspensión inmediata de fenitoína, corticoterapia sistémica, antihistamínicos, cuidados cutáneos y seguimiento multidisciplinario. Se concluye que el reconocimiento temprano de la relación entre la exposición farmacológica y las manifestaciones clínicas es fundamental para reducir complicaciones, orientar el tratamiento y establecer un seguimiento adecuado para prevenir recaídas y secuelas tardías.
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Referencias
Soto Galíndez, B. C. (2023). Hermenéutica e investigación cualitativa, entretejiendo
saberes. Revista Arbitrada del CIEG, 63, 356-369. https://revista.grupocieg.org/wp-content/uploads/2023/11/Ed.63-356-369-Soto-Beda.pdf
Cabañas, R., Ramírez, E., Sendagorta, E., Alamar, R., Barranco, R., Blanca-López, N., et al. (2020). Spanish guidelines for diagnosis, management, treatment, and prevention of DRESS syndrome. Journal of Investigational Allergology and Clinical Immunology, 30(4), 229-253. https://doi.org/10.18176/jiaci.0480
Calle, A. M., Aguirre, N., Ardila, J. C., & Cardona Villa, R. (2023). DRESS syndrome: A literature review and treatment algorithm. World Allergy Organization Journal, 16(3), 100673. https://doi.org/10.1016/j.waojou.2022.100673
De, A., Rajagopalan, M., Sarda, A., Das, S., & Biswas, P. (2018). Drug reaction with eosinophilia and systemic symptoms: An update and review of recent literature. Indian Journal of Dermatology, 63(1), 30-40. https://doi.org/10.4103/ijd.IJD_582_17
Brüggen, M. C., Walsh, S., Ameri, M. M., Anasiewicz, N., Maverakis, E., French, L. E., Ingen-Housz-Oro, S., Horváth, B., & the DRESS Delphi consensus group. (2024). Management of adult patients with drug reaction with eosinophilia and systemic symptoms: A Delphi-based international consensus. JAMA Dermatology, 160(1), 37-44. https://doi.org/10.1001/jamadermatol.2023.4450
Hama, N., Abe, R., Gibson, A., & Phillips, E. J. (2022). Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: Clinical features and pathogenesis. Journal of Allergy and Clinical Immunology: In Practice, 10(5), 1155-1167.e5. https://doi.org/10.1016/j.jaip.2022.02.004
Hasegawa, A., & Abe, R. (2024). Stevens-Johnson syndrome and toxic epidermal necrolysis: Updates in pathophysiology and management. Chinese Medical Journal, 137(19), 2294-2307. https://doi.org/10.1097/CM9.0000000000003250
Kardaun, S. H., Sekula, P., Valeyrie-Allanore, L., Liss, Y., Chu, C. Y., Creamer, D., Sidoroff, A., Naldi, L., Mockenhaupt, M., Roujeau, J. C., & RegiSCAR Study Group. (2013). Drug reaction with eosinophilia and systemic symptoms (DRESS): An original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. British Journal of Dermatology, 169(5), 1071-1080. https://doi.org/10.1111/bjd.12501
Manieri, E., Dondi, A., Neri, I., & Lanari, M. (2023). Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: A narrative review.
Frontiers in Medicine, 10, 1108345. https://doi.org/10.3389/fmed.2023.1108345 Shiohara, T., & Mizukawa, Y. (2019). Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: An update in 2019. Allergology International, 68(3), 301-308. https://doi.org/10.1016/j.alit.2019.03.006
Wang, S., Kang, Y., He, C., & Jin, H. (2024). The systemic treatments for drug reaction with eosinophilia and systemic symptoms (DRESS) beyond corticosteroids. World Allergy Organization Journal, 17(8), 100935. https://doi.org/10.1016/j.waojou.2024.100935
George-Hyslop, F. S., Cherepacha, N., Chugani, B., Alabdeen, Y., Sanchez-Espino, L. F., Mahood, Q., Sibbald, C., & Verstegen, R. H. J. (2025). Drug-specific presentation and outcome of drug reaction with eosinophilia and systemic symptoms (DRESS) in children: A scoping review. Clinical and Experimental Dermatology, 50(2), 408. https://doi.org/10.1093/ced/llae338
Bocquet, H., Bagot, M., & Roujeau, J. C. (1996). Drug-induced pseudolymphoma and drug hypersensitivity syndrome: Drug rash with eosinophilia and systemicsymptoms. Seminars in Cutaneous Medicine and Surgery, 15(4), 250-257. https://doi.org/10.1016/S1085-5629(96)80038-1
Cho, Y. T., Yang, C. W., & Chu, C. Y. (2017). Drug reaction with eosinophilia and systemic symptoms (DRESS): An interplay among drugs, viruses, and immune system. International Journal of Molecular Sciences, 18(6), 1243. https://doi.org/10.3390/ijms18061243
Ortonne, N., Valeyrie-Allanore, L., Bastuji-Garin, S., Wechsler, J., de Feraudy, S., Duong, T. A., Delfau-Larue, M. H., Chosidow, O., & Wolkenstein, P. (2015).
Histopathology of drug rash with eosinophilia and systemic symptoms syndrome: A morphological and phenotypical study. British Journal of
Dermatology, 173(1), 50-58. https://doi.org/10.1111/bjd.13683
Noe, M. H., & Micheletti, R. G. (2020). Diagnosis and management of Stevens-Johnson syndrome/toxic epidermal necrolysis. Clinics in Dermatology, 38(6), 607-612. https://doi.org/10.1016/j.clindermatol.2020.06.016
Coias, J. L., Abbas, L. F., & Cardones, A. R. (2019). Management of Stevens-Johnson syndrome/toxic epidermal necrolysis: A review and update. Current Dermatology Reports, 8(4), 219-233. https://doi.org/10.1007/s13671-019-00275-0
Awad, A., Goh, M. S. Y., & Trubiano, J. A. (2023). Drug reaction with eosinophilia and systemic symptoms: A systematic review. Journal of Allergy and Clinical Immunology: In Practice, 11(6), 1856-1868. https://doi.org/10.1016/j.jaip.2023.02.035
Peter, J., & Lehloenya, R. J. (2023). Drug hypersensitivity in severe cutaneous adverse reactions: Lessons for diagnosis and prevention. Current Opinion in Allergy and Clinical Immunology, 23(4), 281-288. https://doi.org/10.1097/ACI.0000000000000911
