DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome to voxelotor treatment of sickle cell disease

• Published in: The journal of allergy and clinical immunology in practice (Cambridge, MA) Vol. 10; no. 12; pp. 3320 - 3322
• Main Authors: Fargeas, Marine, Calugareanu, Andreea, Pascu, Isabela, Dupire, Gwendy, Aubineau, Magali, Cannas, Giovanna, Ben-Said, Benoit
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2022; Elsevier Limited
• Subjects: Alanine transaminase; Anemia, Sickle Cell - drug therapy; Antibiotics; Anticonvulsants; Antinuclear antibodies; Blood; Blood diseases; Cholestasis; Creatinine; Cytomegalovirus; Drug dosages; Drug Hypersensitivity Syndrome - diagnosis; Eosinophilia; Epstein-Barr virus; Hemoglobin; Hepatitis; Hepatitis B; Hepatitis C; Herpes viruses; HIV; Human immunodeficiency virus; Humans; Hydroxyurea; Parvoviruses; Patients; Polymerization; Renal failure; Serum levels; Severe acute respiratory syndrome coronavirus 2; Sickle cell disease; Skin; Steroids; Viruses
• ISSN: 2213-2198; 2213-2201
• DOI: 10.1016/j.jaip.2022.08.046

Sickle cell disease (SCD), an inherited disorder, leads to polymerization of hemoglobin and formation of sickle cells resulting in vaso-occlusive crises and chronic anemia.1 Although hydroxyurea is still the most commonly used treatment, new molecules are emerging to treat sickle cell patients.2 Voxelotor, was approved by the U.S. Food and Drug Administration for the SCD in 2019. Blood tests revealed lactatemia (4.5 mmol/L, N < 2.2), acute renal failure with increased creatinine level (713 μmol/L, N < 80; Figure 1, A) requiring extrarenal purification session, increased serum levels of alanine aminotransferase (×20 N), and intrahepatic cholestasis. Epstein-Barr virus, cytomegalovirus, parvovirus B19, and human herpes virus 6 blood serologies revealed an old contact, viral serologies (hepatitis B virus, hepatitis C virus, human immunodeficiency virus) as well as repeated blood cultures and antinuclear antibodies remained negative.