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Co-occurrence of clozapine-related DRESS syndrome core clinical manifestations: results of a systematic review

Published online by Cambridge University Press:  01 September 2022

R. De Filippis ,
P. De Fazio ,
J. Kane  and
G. Schoretsanitis
R. De Filippis*
Affiliation:
University Magna Graecia of Catanzaro, Department Of Health Sciences, Catanzaro, Italy
P. De Fazio
Affiliation:
University Magna Graecia of Catanzaro, Department Of Health Sciences, Catanzaro, Italy
J. Kane
Affiliation:
The Zucker Hillside Hospital, Department Of Psychiatry, New York, United States of America
G. Schoretsanitis
Affiliation:
University of Zurich, Psychiatric University Hospital, Zurich, Switzerland
*
*Corresponding author.

Abstract

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Introduction

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome refers to a cluster of clinical symptoms/signs related to drug hypersensitivity. The main clinical features include fever, skin rash, eosinophilia, enlarged lymph nodes, atypical lymphocytosis, and involvement of at least one internal organ. Clozapine-related DRESS syndrome has been rarely reported, but this may be due to a different clinical presentation pattern compared to DRESS for other culprit drugs.

Objectives

We aimed to assess clusters of main clinical features of clozapine-related DRESS.

Methods

We ran a network analysis for clinical manifestations in the pooled sample of all previous published cases of clozapine-related DRESS.

Results

We observed a triad of core symptoms (i.e., organ implication, fever, and eosinophilia) among DRESS criteria co-occurring in 59.3% (n=16) of 27 patients. The organs most likely to be involved in clozapine-related DRESS included lungs, liver, heart, and kidneys. Fever was also present in almost all cases (n=25 patients), while eosinophilia was observed in two thirds of the sample (n=18 patients).

Conclusions

Regarding clinical manifestations clozapine-related DRESS may differ from DRESS for other culprit drugs as skin reaction is not very typical; thus, clinicians need to consider DRESS as a potential diagnosis even in absence of a skin reaction. When managing clozapine-treated patients with the core triad of organ implication, fever, and eosinophilia clinicians should consider guidelines for DRESS treatment.

Disclosure

No significant relationships.

Keywords

psychopharmacologyClozapine-related DRESS syndromeschizophréniadrug hypersensitivity
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S719
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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