Drug-induced hypersensitivity syndrome (DIHS): diagnostic and therapeutic traps. Eight case reports

Purpose.-Drug-induced hypersensitivity syndrome (DIHS) is an acute and seve re drug reaction. Manifestations include severe skin lesions, fever, nodal enlargement, blood eosinophilia and multisystemic involvement The severe sy stemic manifestations of DIHS are responsible for a 10% mortality rate. The pertinence of corticosteroid therapy is discussed. Methods.-The authors report eight retrospective cases of DIHS obtained from the PMSI (Programme de Medicalisatiopn des Systemes d'Information) between November 1991 and November 1998. Results.-The series consisted of five male and three female patients (mean age: 52.6 years; range: 23-83 years). The interval between the introduction of the drug and the onset of the reaction varied from two to eight weeks. Due to severe systemic manifestations, three patients were given corticoste roid therapy. Healing of skin and systemic disorders resolved with a mean d elay of 4.4 weeks (range: 1 to 56 weeks). Conclusion.-DIHS can be a diagnostic trap, as there are no diagnostic crite ria for DIHS. Only the association of multiple arguments such as the time t o the occurrence of symptoms, clinical similarity to many infectious illnes ses, hypereosinophilia, atypical lymphocytosis, etc. may help guide diagnos is. DIHS can also be a therapeutic trap, as prompt withdrawal of the offend ing drug is essential to minimize morbidity. Although still controversial i n the literature, the pertinence of corticosteroid therapy may be discussed in case of severe systemic effects. Patch testing can be a valuable tool t o determine the responsibility of a drug; however it proves to be useful on ly when positive. (C) 2000 Editions scientifiques et medicales Elsevier SAS .