Retrospective Analysis Of 86 Cases Of Drug-Induced Hypersensitivity Syndrome

Object:Drug-Induced Hypersensitivity Syndrome（DIHS）,or Drug Reaction With Eosinophilia And Systemic Symptom（DRESS）,is one of the severe drug eruptions and seriously threatens human life health.However,to date,there are few clinical studies on this disease in China and the world.This article aims to analyze the etiology,clinical manifestations,treatment,and prognosis of this disease in the Chinese population through a retrospective case investigation.Method:1.By searching all the patients diagnosed as DIHS reported by the China Knowledge Resource Database（CNKI）and Wanfang Database from January 1,2015 to December 31,2019,and retrospectively analyzed from Fujian Medical Information on patients diagnosed as DIHS in the inpatient department of the dermatology department of the First Affiliated Hospital of the University.2.Apply SPSS.26 statistical software for data processing.Measurement data is expressed as mean±standard deviation（?x±s）,t test is used for normal distribution,rank sum test is used for non-normal distribution,andχ² test is used for comparison of count data.Definition P<0.05,the difference is statistically significant.Result:（1）General information1.The number of reported cases over the past 5 years has shown steady fluctuations:15 in 2015,15 in 2016,23 in 2017,20 in 2018,and 13 in 2019.2.Among 86 patients with DIHS,the male to female ratio was 1.3:1,which was mainly distributed in the age group of 45-74 years（n=47,54.7%）.3."Erythema combined with papules"is the most common first manifestation of the disease（n=45,52.3%）,followed by"erythema only"（n=20,23.3%）and"fever"（n=13,15.1%）.The first three most common types of skin lesions are:erythema in 86 cases（100%）,papules in 63 cases（73.3%）,and scales in 26 cases（30.2%）.4.In this study,the patient’s mucosal involvement rate was 33.7%.The positive rate of fecal occult blood test（FOBT）in the mucosal involvement group was significantly higher than that in the non-mucosa involvement group（?2=15.151,P=0.0001<0.05）.5.Superficial lymphadenopathy accounted for 69.8%,and the top three most common sites were:axilla（21.1%）,anterior neck（17.7%）,posterior neck/submandibular（15.0%）.Moderate-high fever（38.1℃—41℃）is the most common fever interval（n=80,93.0%）.6.All patients were combined with systemic diseases before the onset.The most common first three categories were endocrine metabolism（n=30,28.0%）,neuropsychiatric（n=22,20.6%）,cardiovascular（n=20,18.7%）.（2）Incubation period and sensitizing drugs1.The average incubation period is 25.24±15.92 days.2.The situation of sensitizing drugs:50 cases（58.1%）were sensitized by single drug,16 cases（18.6%）were suspected by double drug susceptibility,4 cases（4.7%）were suspected by three drug susceptibility,and 7 cases were sensitized by suspicious three drugs（8.1%）,9 unknown cases（10.5%）.3.In single-agent sensitization,the most common top 4 positions are:allopurinol in20 cases（40.0%）,sulfasalazine in 11 cases（14.0%）,carbamazepine andβ-lactam There were 5 cases of antibiotics（10.0%）and 3 cases of non-steroidal anti-inflammatory drugs（6.0%）.4.Among the susceptible drugs with more than three suspected drugs,anti-tuberculosis drugs（isoniazid,rifampicin,pyrazinamide,ethambutol）accounted for the highest proportion,reaching 4 cases（57.1%）.（3）Analysis of laboratory inspection results Ⅰ.Blood,liver and kidney system1.The three most common abnormal indicators in peripheral blood routine are:lymphocyte count（n=45,80.3%）,white blood cell count（n=40,71.4%）;platelet count（n=19,33.9%）.2.A total of 48 patients（85.7%）had abnormal liver function,and 33 patients（58.9%）had abnormal renal function.The incidence of renal impairment caused by allopurinol was higher than that of sulfasalazine and antiepileptic drugs（χ₁²=6.519,P₁=0.011<0.05,χ₂²=10.542,P₂=0.001<0.05）.Ⅱ.Infection1.In this study,33.9%of patients were positive for viral antibodies,and patients with positive EBV Ig M antibodies had a longer course of disease than patients with negative antibodies（P=0.05）.Ⅲ.Autoantibodies1.In this study,there were 20 patients with positive autoantibodies.The three most common autoantibodies were:anti-ANA antibody（n=5,8.9%）,anti-Ro52 antibody（n=5,8.9%）,and anti-SSA antibody（n=4,7.1%）.（4）Treatment and efficacy1.Of the 86 patients,5 were discharged automatically and 3 died,with a mortality rate of 3.5%.2.In this study,the systemic glucocorticoid-only treatment group had a shorter progression time（P=0.03<0.05）and the total length of hospital stay（P=0.003）than the systemic glucocorticoid combined with IVIG treatment group,P<0.05).Conclusion:1.The systemic diseases associated with DIHS patients are the most common endocrine and metabolic diseases;"simultaneous erythema and papules"is the most common first clinical manifestation of the disease;fever patients are mainly moderate to high fever（38.1℃—41℃）;The positive rate of fecal OB in patients with mucosal involvement was significantly higher than that without mucosal involvement;axillary lymph nodes were the most common in superficial lymphadenopathy.2.The average incubation period of this disease is 25.24±15.92 days.In this study,the most common single-agent sensitizers that caused DIHS were allopurinol,sulfasalazine,and carbamazepine/β-lactam antibiotics.Quadruple anti-tuberculosis drugs（isoniazid,rifampicin,pyrazinamide,ethambutol）are the most common combination types of suspected sensitizing drugs above three drugs.3.The incidence of liver function damage in patients with DIHS is higher than that of renal function damage.The incidence of renal impairment caused by allopurinol is significantly higher than that of sulfasalazine and antiepileptic drugs.Patients with positive EBV Ig M have a longer disease course than patients with negative.4.In this study,only the systemic glucocorticoid monotherapy group had better efficacy than the systemic glucocorticosteroid combined with IVIG treatment group in terms of shortening the rash progression time and the total number of days in hospital.It may be the result of selection bias,which needs to be further confirmed by studies with larger sample sizes.