DRESS Syndrome and Hepatosplenomegaly
Yes, DRESS syndrome can present with hepatosplenomegaly as part of its multi-organ involvement, though it is not among the most common manifestations.
Clinical Presentation of Hepatosplenomegaly in DRESS
Hepatosplenomegaly has been documented in DRESS syndrome cases, occurring alongside other systemic manifestations:
- Hepatosplenomegaly can occur in DRESS syndrome as part of the systemic organ involvement that characterizes this severe drug reaction 1, 2
- A documented case of leflunomide-induced DRESS syndrome specifically reported hepatosplenomegaly along with fever, facial edema, liver injury, skin rash, and eosinophilia 1
- Another case of carbamazepine-induced DRESS presented with hepatosplenomegaly, high fever, and leukocytosis that initially mimicked sepsis 2
Primary Organ Involvement in DRESS
While hepatosplenomegaly can occur, the more common patterns of organ involvement include:
- Hepatitis is the most frequent internal organ manifestation, with liver involvement occurring commonly and presenting as elevated transaminases (ALT >2 times upper limit of normal) 3, 4, 5
- Constitutional symptoms including fever (>38°C), rigors, myalgias, and arthralgias are commonly present 6, 4
- Other organ systems that may be involved include the kidneys (nephritis), lungs (pneumonitis), heart (myocarditis, pericarditis), and lymph nodes (lymphadenopathy) 6, 3, 7
Diagnostic Considerations
When hepatosplenomegaly is present in DRESS syndrome:
- The combination of hepatosplenomegaly with high fever and leukocytosis can mimic sepsis, potentially leading to diagnostic confusion and delayed recognition of DRESS 2
- A complete workup should include liver function tests, complete blood count with differential to assess for eosinophilia, and evaluation of other organ systems 3, 4
- The RegiSCAR diagnostic criteria include organ involvement (liver, kidney, heart, lung) as a key feature, with liver dysfunction defined as ALT >2 times upper limit of normal 4
Clinical Pitfall
A critical pitfall is mistaking DRESS syndrome with hepatosplenomegaly for an infectious process like sepsis, which can lead to continuation of the offending drug while treating with antibiotics, worsening the patient's condition 2. The latency period of 2-6 weeks after drug initiation and the presence of eosinophilia should raise suspicion for DRESS rather than infection 7, 4.