Síndrome de hipersensibilidad a fármacos

Abstract

The term drug hypersensitivity syndrome (DHS) includes different entities which describe a common pattern consisting on a severe drug reaction, characterized by the triad fever, cutaneous affectation and multiple organ affectation. Occasionally, lymphadenopathy and eosinophilia have been considered to be included into this entity. It is estimated that between 10 and 20% of the hospitalized patients and 7% of people in general can suffer from a drug reaction, and that one third of them are severe. The most common cause of DHS are the aromatic antiepileptic drugs, mainly phenytoin and carbamazepine but we can add to this list a large number of drugs, among which we emphasize minocycline and the antiretroviral drugs. The etiopathogenic of DHS is not well-known but the production of reactive metabolites by involved drugs, immunologic mechanisms as retard hypersensitivity or the presence of specific virus (herpes virus, VIH) have been considered as possible etiopathogenical mechanisms. The clinical cutaneous presentation in these patients is very variable (generalized rash, eczematous dermatitis, exfoliative dermatitis, pseudolymphoma, etc.), the same as the clinical extracutaneous presentation (lymphadenopathy, hepatic affectation, hematologic affectation, etc.). In 10% of the patients, prognosis can be fatal, mainly aused by a hepatic failure. Nowadays, systemic corticosteroids in high doses (1-2 mg/kg a day) are the treatment of choice in this kind of patients.