Table 1. Diagnostic criteria of DRESS, DIHS & SJS [1, 5, 18]
|
Diagnostic Criteria |
DRESS* |
1. Fever ≥38.5°C (No: -1 points; Yes: 0 points) 2. Lymphadenopathy (No: 0 points; Yes: 1 point) 3. Eosinophilia (No: 0 points; 0.7-1.499x109L-1: 1 point; ≥1.5x109L-1: 2 points) 4. Atypical lymphocytes (No: 0 points; Yes: 1 point) 5. Skin involvement (No: 0 points; >50%: 1 point) 6. Organ involvement (No: 0 points; Yes: 1 point) 7. Resolution ≥15 days (No: -1 points; Yes: 0 points) 8. No other potential causes (1 point) |
DIHS* |
Typical DIHS requires all of the following 7 criteria (Atypical DIHS requires only the first 5): 1. Maculopapular rash ≥ 3 weeks after initiating drug 2. Symptoms present 2 weeks after stopping drug 3. Fever ≥38.5°C 4. Elevated liver enzymes 5. Leukocyte abnormalities 6. Lymph node enlargement 7. Human Herpes Virus 6 reactivation |
SJS* |
*No universally accepted diagnostic criteria, but clinical and histological findings include: 1. Fever & malaise post drug exposure 2. Erythematous macules progressing to vesicles/bullae 3. Necrosis and sloughing of epidermis (<10% surface body area) 4. Conjunctiva & mucous membrane involvement typical 5. Biopsy findings: full thickness epidermal attachment with splitting & minimal inflammatory infiltrate
|
*DRESS= Drug Rash with Eosinophilia and Systemic Symptoms; DIHS= Drug-Induced
Hypersensitivity Syndrome; SJS= Steven-Johnson Syndrome