Scoring System May Help Screen High-Risk Patients for Cytomegalovirus Disease, Complications

DRESS Syndrome
DRESS Syndrome
Investigators sought to determine a scoring system for DiHS/DRESS that may be used to monitor severity and stratify risk for developing CMV disease and complications.

A unique scoring system offers the possibility of predicting cytomegalovirus (CMV) disease and complications in patients with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DiHS/DRESS). Study results were published in the Journal of the American Academy of Dermatology.

Investigators conducted a retrospective analysis of patients with DiHS/DRESS to establish a scoring system for the disorders that could be used to monitor severity, predict prognosis, particularly fatal complications, and stratify risk for developing CMV disease and complications. Researchers theorized that patients with DiHS/DRESS who go on to develop fatal complications would differ from patients with the ability to overcome these complications.

The researchers evaluated a total of 55 patients (33 women and 22 men) with DiHS/ DRESS and created a composite score using clinical data. The mean participant age was 54.5±20.0 (range 14 to 88). Patients with DiHS/DRESS were stratified into 3 groups based on their scores in order to predict their risk for CMV reactivation and associated complications. Mild disease was defined as scores <1 (n=5), moderate disease as scores of 1 to 3 (n=23), and severe disease as scores ≥4 (n=27).

The new scoring system enabled the prediction of CMV disease and its complications in patients who were assessed. Scores of ≥4 were associated with the later development of CMV and its complications in 5 of 26 patients, whereas no patients with scores <4 developed complications from CMV. A positive relationship was observed between the age of DiHS/DRESS onset and a patient’s score.

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The investigators concluded that the use of this scoring system may help predict CMV-related complications. Early intervention with the use of anti-CMV agents should be considered in patients with scores ≥4 and/or patients who exhibit evidence of CMV reactivation. Limitations of the current study include its retrospective nature, single-institution assessment, lack of a validation cohort, and limited follow-up time.

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Mizukawa Y, Hirahara K, Kano Y, Shiohara T. Drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) severity score: A useful tool for assessing disease severity and predicting fatal cytomegalovirus disease [published online September 18, 2018]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.08.052.