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World J Clin Cases. Mar 26, 2019; 7(6): 705-716
Published online Mar 26, 2019. doi: 10.12998/wjcc.v7.i6.705
Liver involvement in the drug reaction, eosinophilia, and systemic symptoms syndrome
Sylvia A Martinez-Cabriales, Neil H Shear, Emmanuel I Gonzalez-Moreno
Sylvia A Martinez-Cabriales, Neil H Shear, Department of Medicine, Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
Sylvia A Martinez-Cabriales, Internal Medicine Department, Dermatology Division, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, Mexico
Emmanuel I Gonzalez-Moreno, Department of Medicine, Division of Gastroenterology, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
Emmanuel I Gonzalez-Moreno, Internal Medicine Department, Gastroenterology Division, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León 64460, Mexico
Author contributions: Martinez-Cabriales SA designed research, performed research, analyzed data, wrote the paper, and approved the final manuscript version; Shear NH analyzed data, wrote the paper, and approved the final manuscript version; Gonzalez-Moreno EI designed research, performed research, analyzed data, wrote the paper, and approved the final manuscript version.
Conflict-of-interest statement: The authors have no conflict of interest and no financial support to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Emmanuel I Gonzalez-Moreno, MD, Assistant Professor, Staff Physician, Department of Medicine, Division of Gastroenterology, University of Calgary, Teaching, Research, and Wellness Building, 6D58, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada. emmanuel.gonzalezmor@ucalgary.ca
Telephone: +1-403-5925089
Received: September 5, 2018
Peer-review started: September 6, 2018
First decision: October 11, 2018
Revised: February 5, 2019
Accepted: February 26, 2019
Article in press: February 26, 2019
Published online: March 26, 2019
Core Tip

Core tip: Drug reaction, eosinophilia, and systemic symptoms syndrome (DReSS) is considered a severe cutaneous drug reaction. It can present with a broad spectrum of clinical manifestations making its diagnosis challenging. Factors associated with a poor prognosis include delayed diagnosis, viral reactivation, the presence of systemic inflammatory response syndrome, and severe organ involvement. Liver injury, presented in more than half of DReSS patients, ranges from mild transaminasemia to acute liver failure and is one of the most common causes of death in these patients. Prompt withdrawal of the culprit agent and a multidisciplinary approach in patients with internal organ affection are of utmost importance.