Liver involvement in the drug reaction, eosinophilia, and systemic symptoms syndrome

Table 1 RegiSCAR scoring system for classifying drug reaction, eosinophilia, and systemic symptoms syndrome/drug-induced hypersensitivity syndrome

Clinical manifestations	SCORE				Range
	-1	0	1	2	Min	Max
Fever	No/U	Yes			-1	0
Enlarged lymph nodes		No/U	Yes		0	1
Eosinophilia
Eosinophils		No/U	700-1499/μL	≥ 1500/μL	0	2
Eosinophils, if leukocytes < 4000		No/U	(10%-19.9%)	(≥ 20%)	0	2
Atypical lymphocytes		No/U	Yes		0	1
Skin involvement
Skin rash extent, % BSA		No/U	> 50%		-2	2
Skin rash suggesting DReSS	No	U	Yes
Biopsy suggesting DReSS	No	Yes/U
Organ involvement1
Liver		No/U	Yes		0	2
Kidney		No/U	Yes		0	2
Lung		No/U	Yes		0	2
Muscle/heart		No/U	Yes		0	2
Pancreas		No/U	Yes		0	2
Other organ(s)		No/U	Yes		0	2
Resolution ≥ 15 d	No/U	Yes			-1	0
Evaluation other potential causes: ANA; blood culture; serology for HVA/HVB/HVC/Chlamydia-/ Mycoplasma pneumonia; other serology/PCR.
If none positive and ≥ 3 of above negative			Yes		0	1
Total score					-4	9
Final score meaning: < 2: no case; 2-3 possible case; 4-5: probable case; and > 5: definite case

¹After exclusion of other explanations: 1 = 1 organ, 2 = ≥ 2 organs. Adapted from Kardaun et al[21]. U: Unknown/unclassifiable; DReSS: Drug reaction, eosinophilia, and systemic symptoms syndrome; ANA: Antinuclear antibody; PCR: Polymerase chain reaction.