Acute generalized exanthematous pustulosis to a novel oral anticoagulant (apixaban).

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially life-threatening T-cell mediated hypersensitivity reaction involving the skin and visceral organs.1 The syndrome is heterogenous, unpredictable, and difficult to diagnose. Three cases of DRESS due to rivaroxaban have been reported, including two with a mild eosinophilia <1.1×109/L.2–4 One case of DRESS due to apixaban, another factor Xa inhibitor, has been reported.5 Cases of drug-induced liver injury (DILI) due to rivaroxaban without DRESS have also been reported. 

A case of drug reaction with eosinophilia and systemic symptoms (DRESS) due to rivaroxaban

Bevacizumab

Bemiparin-sodium

Pediatric Blood & CancerVolume 70, Issue 11 e30622 LETTER TO THE EDITOR Enoxaparin-induced DRESS syndrome in a pediatric patient Aarti Kamat, Corresponding Author Aarti Kamat [email protected] orcid.org/0000-0003-2789-0085 Department of Pediatrics, University of Michigan Medicine Medical School, Ann Arbor, Michigan, USA Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA Correspondence Aarti Kamat, Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, 1540 E. Hospital Dr, Ann Arbor, MI 48109, USA. Email: [email protected]Search for more papers by this authorMary McGrath, Mary McGrath Department of Pediatrics, University of Michigan Medicine Medical School, Ann Arbor, Michigan, USA Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USASearch for more papers by this authorAngela Weyand, Angela Weyand orcid.org/0000-0003-2595-8541 Department of Pediatrics, University of Michigan Medicine Medical School, Ann Arbor, Michigan, USA Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USASearch for more papers by this author Aarti Kamat, Corresponding Author Aarti Kamat [email protected] orcid.org/0000-0003-2789-0085 Department of Pediatrics, University of Michigan Medicine Medical School, Ann Arbor, Michigan, USA Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA Correspondence Aarti Kamat, Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, 1540 E. Hospital Dr, Ann Arbor, MI 48109, USA. Email: [email protected]Search for more papers by this authorMary McGrath, Mary McGrath Department of Pediatrics, University of Michigan Medicine Medical School, Ann Arbor, Michigan, USA Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USASearch for more papers by this authorAngela Weyand, Angela Weyand orcid.org/0000-0003-2595-8541 Department of Pediatrics, University of Michigan Medicine Medical School, Ann Arbor, Michigan, USA Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USASearch for more papers by this author First published: 14 August 2023 https://doi.org/10.1002/pbc.30622 This paper has been published as a meeting abstract: Drug reaction with eosinophilia and systemic symptoms syndrome associated with enoxaparin therapy. American Society of Pediatric Hematology and Oncology Conference, April 2022. Published in Pediatric Blood and Cancer, June 2022. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Pye B, Aguilar JM, Maranich AM. A 15-year-old boy presents with fever and pruritic rash for 6 days. Pediatr Rev. 2021; 42(1): S63-S66. 2Dabas G, De D, Handa S, et al. Delayed-type hypersensitivity reaction to enoxaparin in a pregnant woman. Postgrad Med J. 2019; 95: 506. 3Ronceray S, Dinulescu M, Gall F, et al. Enoxaparin-induced DRESS syndrome. Case Rep Dermatol. 2012; 4(3): 233-237. 4Menteşoğlu D, Doğan Günaydın S, Ersoy-Evans S. Drug reaction with eosinophilia and systemic symptoms syndrome induced by apixaban. Dermatol Ther. 2020; 33:e13719. 5O'Brien SH, Stanek JR, Witmer CM, Raffini L. The continued rise of venous thromboembolism across US children's hospitals. Pediatrics. 2022; 149(3):e2021054649. doi:10.1542/peds.2021-054649 6Cardones AR. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Clin Dermatol. 2020; 38(6): 702-711. Volume70, Issue11November 2023e30622 ReferencesRelatedInformation 

Enoxaparin‐induced DRESS syndrome in a pediatric patient

Dear Editor, Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by severe cutaneous eruption, fever, lymphadenopathy, hepatitis, and hematologic abnormalities including eosinophilia and atypical lymphocytes. Apixaban is an oral, direct and highly selective factor Xa inhibitor and is used to prevent venous thromboembolic events. The most common adverse effect is bleeding. Herein, we report the first case with DRESS syndrome most likely induced by apixaban. A 69-year-old female patient was admitted to our hospital with complaints of generalized maculopapular rash, fever, and facial edema. She had a past medical history of chronic renal failure and atrial fibrillation, and had been taking apixaban 5 mg orally twice daily for 6 weeks. On dermatological examination, severe midfacial edema (Figure 1) and widespread erythematous macules, papules and plaques were noted on the trunk (Figures 2 and 3). Nikolsky sign was negative. Conjunctiva, oral, and anogenital mucosa were normal. Physical examination revealed no palpable lymphadenopathies. The peripheral blood tests results showed anemia (hemoglobin 9,6 mg/dL [3,6-17,2]), 10% eosinophils, 40% atypical lymphocytosis and elevated C-reactive protein level 3,35 mg/dL (0-0,6); serum creatinine level was 3,52 mg/dL (0,66-1,09), blood urea nitrogen was

Drug reaction with eosinophilia and systemic symptoms syndrome induced by apixaban.

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