THE ASSOCIATION BETWEEN HISTORY OF CONSUMING CEFADROXIL WITH THE OCCURENCE OF STEVEN-JOHNSON SYNDROME AT RSU Dr.

SOEDARSO PONTIANAK IN PERIOD 2007- 2010 Mega Heksana Devi1; Retno Mustikaningsih, dr., M.Kes, Sp.KK2; Andriani, dr.3 ABSTRACT Background: Steven-Johnson syndrome is a hypersensitivity disease was mediated by immune complexes caused by some drugs or infections. The incidence of Stevens-Johnson syndrome induced by drug allergy is increasing in Indonesia. Cefadroxil is a high risk Stevens-Johnson syndrome cause. Objective: To determine association between history of cefadroxil with the occurrence of Steven-Johnson syndrome at RSU dr.Soedarso Pontianak in period 2007- 2010. Method: This is an analytic observational with retrospective study. Ninety five samples were participated. Data was processed by chi square test. Result: Based on the history of the use of cefadroxil, 14 people were diagnosed with Stevens-Johnson Syndrome and 18 people were diagnosed with other forms of Drug Eruption, while based on a history of drug use other types, 26 people were diagnosed with Stevens-Johnson Syndrome and 37 people were diagnosed Drug Eruption. The results show the value of p = 0.817, PR = 1,060, 95% confidence interval = 0.649 to 1.732. Conclusion: There is no significant association between history of consuming cefadroxil and Steven-Johnson syndrome occurrence.

The DRESS Syndrome: A Literature Review

Patrice Cacoub, MD, PhD,a,b Philippe Musette, MD, PhD,c Vincent Descamps, MD, PhD,e,f Olivier Meyer, MD, PhD,g Chris Speirs, MD,h Laetitia Finzi, MD, PhD,i Jean Claude Roujeau, MDd

ABSTRACT The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. We used the RegiSCAR scoring system that grades DRESS cases as no, possible, probable, or definite to classify cases reported in the literature. We also analyzed the clinical course and treatments of the cases. A total of 44 drugs were associated

with the 172 cases reported between January 1997 and May 2009 in PubMed and MEDLINE. The most frequently reported drug was carbamazepine, and the vast majority of cases were classified as probable/definite DRESS cases. Hypereosinophilia, liver involvement,fever, and lymphadenopathy were significantly associated with probable/definite DRESS cases,whereas skin rash was described in almost all of the cases, including possible cases. Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. The outcome was death in 9 cases. However, no predictive factors for serious cases were found. This better knowledge of DRESS may contribute to improve the diagnosis and management of this syndrome in cl inical practice. 2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 588-597
DRESS syndrome from cefadroxil confirmed by positive patch test
Suswardana*, M. Hernanto, B. A. D. Yudani, S. R. Pudjiati, N. Indrastuti Key words: cefadroxil; DRESS syndrome; positive

patch test.

A 51-year-old man was diagnosed with osteomyelitis, a complication that developed in the aftermath of an orthopedic surgery on his right tibia. He took cefadroxil 500 mg bid for 9 weeks until his admission to our hospital.Aweek prior to his admission, he had developed fever, myalgia, arthralgia, and skin rash. Physical examination showed that he had mild fever, generalized maculopapular exanthem, and multiple purpuric patches which gradually developed to exfoliative dermatitis. No lymphadenopathy was found. Pus was found on the gaping wound on his right tibia. Laboratory tests found leucocytosis (80.43 103/ll), absolute eosinophilia (33.780/ll), lymphocytosis (20.911/ll), atypical lymphocytes, abnormal liver, and renal function (AST 112.4 IU/l, ALT 57.6 IU/l, BUN 32.9 mg/dl, CRE 1.48 mg/dl), increasing ALP (286 IU/l) and decreasing total protein and albumin (TP 6.23 g/dl, ALB 2.78 g/dl). HBsAg were negative. Streptococcus epidermidis was positive on pus culture; however, the blood culture showed no bacteria. Cefadroxil was stopped; we gave him

methylprednisolone equivalent to 1.3 prednisone/mg BW/day, clindamycin 300 mg tid and wound care for a week. The patient_s health condition improved remarkably, attested by laboratory tests.He was afterwards discharged from the hospital. The methylprednisolone was continued and tapered-off for a week. Two weeks later, the DRESS syndrome relapsed. Treatment with a similar dosage of methylprednisolone, with a slower gradual tapering-off for 4 weeks was performed until complete recuperation.z