• Philippe Ichai, Astrid Laurent-Bellue, Faouzi Saliba, David Moreau, Camille Besch, Claire Francoz, Laurence Valeyrie-Allanore, Sylvie Roussin Bretagne, Marc Boudon, Teresa Maria Antonini, Florent Artru, Gabriella Pittau, Olivier Roux, Daniel Azoulay, Eric Levesque, François Durand, Catherine Guettier, and Didier Samuel.
• 1 APHP Hôpital Paul-Brousse, Centre Hépato-Biliaire Villejuif, France. 2 INSERM, Unité 1193, Univ Paris-Saclay, Villejuif, France. 3 Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France. 4 DHU Hepatinov, Villejuif, France. 5 Department of Anatomo-Pathology, APHP Hôpital Bicêtre, Le Kremlin-Bicêtre, France. 6 Department of Liver Surgery and Transplantation, Hôpital de Hautepierre, Strasbourg, France. 7 Department of Hepatology, Liver Intensive Care, APHP Hôpital Beaujon, Clichy, France. 8 Department of Dermatology, APHP Hôpital Henri Mondor, Créteil, France. 9 Department of Dermatology, Hôpital André Mignot, Le Chesnay, France. 10 Department of Liver Surgery, APHP Hôpital Henri Mondor, Créteil, France. 11 Intensive Care Unit, APHP Hôpital Henri Mondor, Créteil, France.
• Transplantation. 2017 Aug 1; 101 (8): 1830-1837.

BackgroundDrug reaction with eosinophilia and systemic symptoms (DRESS) is a rare severe adverse drug-induced reaction with multiorgan involvement. The outcome and prediction of those patients who develop severe acute liver injury (sALI) or acute liver failure (ALF) remain little known.MethodsA multicenter retrospective study of patients admitted with a diagnosis of DRESS-related sALI or ALF. Histological review was performed on liver core biopsies from native livers.ResultsSixteen patients (11 women, 5 men; mean age, 39±17.2 years) were classified as having definite (n=13) or probable (n=3) DRESS. At admission, 3 patients had hepatic encephalopathy; median levels of prothrombin time, INR, and total bilirubin were, respectively, 33% (Q1-Q3, 21-41), 2.74 (1.98-4.50), and 94 μmol/L (Q1-Q3, 39.5-243.5). Nine patients received corticosteroid therapy. Overall, 9 patients improved spontaneously and 7 worsened (liver transplantation [LT] (n=5), deceased (n=2)). Transplantation-free and post-LT survival was 56% and 60%, respectively. After LT, DRESS recurrence was observed in 3 of 5 patients. Systemic corticosteroid therapy was not significantly associated with a clinical improvement. In the multivariate analysis, factor V level less than 40% at day 0 and factor V levels of 40% or greater at admission but decreasing at day 2 were associated with worse outcome. Pathological findings (n=7) revealed atypical lymphoid infiltrates, Kupffer cell hyperplasia with erythrophagocytosis, and an inconstant presence of eosinophils.ConclusionsThe spontaneous prognosis of patients with sALI/ALF due to DRESS is poor and was not improved by corticosteroid therapy. Histology is helpful to establish diagnosis. Dynamic variables regarding factor V values are predictive of a poor outcome.

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