| Abstrakt: |
Background: DRESS syndrome (drug reaction with eosinophilia and systemic symptoms syndrome) is a severe druginduced skin reaction that may be life-threatening, particularly due to its visceral involvement. The liver is the primary organ responsible for the metabolism of most medications. Several reviews and articles have highlighted the liver as the most affected organ in DRESS syndrome, making it intriguing to study this aspect in more detail. Materials and Methods: This was a retrospective, descriptive, and analytical study conducted at the dermatology department in Fez, Morocco, from 2014 to 2023, including all cases presenting with DRESS syndrome diagnosed based on clinical, biological, histological, and chronological arguments, with a RegiSCAR score classified as probable or definite. Hepatic involvement was assessed based on the classification of drug-induced hepatitis using alkaline phosphatase (ALP) levels, alanine aminotransferase (ALT) levels, and the ALT/ALP ratio (R), thus defining three clinical forms: cytolytic (ALT > 2 or R > 5), cholestatic (ALP > 2 or R < 2), and mixed (2 < R < 5). Results: 72 patients were included, with 47.2% experiencing hepatic involvement, including 48.5% with cytolytic, 36.4% with cholestatic, and 15% with mixed forms. Among these, 55.9% had associated renal involvement, 29.9% presented with erythroderma, 55.9% with a maculopapular rash, 8.8% with a morbilliform rash, 5.9% with an erythema multiforme-like eruption, and 79.9% had eosinophilia. Allopurinol was the most implicated drug (50%), followed by neuroleptics (17.6%), Salazopyrin (14.7%), and antibiotics (8.8%). The association between Salazopyrin and hepatic involvement was significant (p < 0.05), while the statistical analysis of other parameters did not reveal such an association. Management involved local care, with 50% of the patients placed on corticosteroid therapy. 8.8% of the patients died, while the others showed normalized liver function tests in 74.19% of cases, with the rest lost to follow-up. Conclusion: Hepatic involvement is common in DRESS syndrome, predominantly manifesting as cytolytic or cholestatic patterns. Maculopapular rash and erythroderma are the most commonly observed cutaneous phenotypes. These patients are more likely to have associated renal involvement and eosinophilia. Allopurinol, neuroleptics, and Salazopyrin are the most frequently implicated drugs. [ABSTRACT FROM AUTHOR] |
