Adult respiratory distress syndrome (ARDS) due to omeprazole-induced drug reaction with eosinophilia and systemic symptoms (DRESS): Case report and review of the literature

Abstract

Eosinophilia in not an uncommon findings in the intensive care unit (ICU); however, DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome, which is characterized by a hypersensitivity reaction to drugs and manifests as eosinophilia, systemic involvement and maculopapular erythematous rash 2–6 weeks after exposure to the offending drug, is an exceptional occurrence. We present the first case described in the literature of DRESS syndrome with pulmonary involvement in the form of interstitial pneumonitis and persistent adult respiratory distress syndrome (ARDS) secondary to proton pump inhibitors (PPI). The patient made a good recovery after withdrawal of the offending drug and long-term treatment with systemic corticosteroids.

We also present a systematic review of all cases of DRESS with pulmonary involvement in the form of interstitial pneumonitis and cases of PPI-induced DRESS published to date; none of these describe pulmonary involvement.

Resumen

El hallazgo de eosinofilia en la unidad de cuidados intensivos (UCI) no es infrecuente, sin embargo, la detección del síndrome de DRESS (DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) caracterizado por una reacción de hipersensibilidad a fármacos, que cursa con eosinofilia, afectación sistémica y erupción eritematosa maculopapular tras 2–6 semanas después de la exposición al fármaco responsable, es algo excepcional. Presentamos el primer caso descrito en la literatura de síndrome DRESS con afectación pulmonar en forma de neumonitis intersticial o distrés respiratorio del adulto (SDRA) persistente, secundario a inhibidores de la bomba de protones (IBP), con evolución favorable tras retirada del fármaco responsable y tratamiento prolongado con corticoides sistémicos.

Además, presentamos una revisión sistemática propia de los casos de DRES con afectación pulmonar en forma de neumonitis intersticial, así como los casos de DRES provocados por IBP publicados en la literatura hasta hoy, ninguno de ellos con afectación pulmonar.