Pulmonary Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review
Table 1
DRESS validation score, known as RegiSCAR (adapted from Kardaun).
Score
−1
0
1
2
Min
Max
Fever ≥38.5°C
No/U
Yes
−1
0
Enlarged lymph nodes
No/U
Yes
0
1
Eosinophilia
No/U
0
2
Eosinophils
700–1499/μl
≥1500/μl
Eosinophils, if leukocytes <4000
10–19.9%
≥20%
Atypical lymphocytes
No/U
Yes
0
1
Skin involvement
−2
2
Skin rash extent (% BSA)
No/U
>50%
Skin rash suggesting DRESS
No
U
Yes
Biopsy suggesting DRESS
No
Yes/U
Organ involvement
0
2
Liver
No/U
Yes
Kidney
No/U
Yes
Lung
No/U
Yes
Muscle/heart
No/U
Yes
Pancreas
No/U
Yes
Other organ(s)
No/U
Yes
Resolution ≥ 15 days
No/U
Yes
−1
0
Evaluation of other potential causes
ANA
Blood culture
Serology for HVA/HVB/HVC/Chlamydia/Mycoplasma pneumoniae
Other serology/PCR
If none, positive, and ≥3 or above, negative
Yes
0
1
Total score
−4
9
BSA, body surface area; HAV, hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; DIHS, drug-induced hypersensitivity syndrome; DRESS, drug reaction/rash with eosinophilia and systemic symptoms; SCAR, severe cutaneous adverse reactions; U, unknown/unclassifiable. After exclusion of other explanations: 1 = 1 organ; 2 = ≥2 organs. Final score <2: no case; final score 2-3: possible case; final score 4-5: probable case; final score >5: definite case.
