Jean-David Bouaziz

Background: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare but potentially life‐threatening drug‐induced hypersensitivity reaction. Approximately 15% of patients require admission to an intensive care unit (ICU). Objectives: To identify factors associated with ICU admission in patients with DRESS in order to improve risk stratification and management. Methods: We conducted a multicentre retrospective cohort study including adult patients with probable or definite DRESS (RegiSCAR score ≥4) hospitalized in Greater Paris area hospitals between July 2017 and January 2023. Data were extracted from the Assistance Publique‐Hôpitaux de Paris Health Data Warehouse, covering 39 centres. The primary endpoint was DRESS‐related ICU admission. Secondary endpoints included in‐hospital mortality and therapeutic interventions inside and outside the ICU. Results: A total of 207 DRESS cases were included of whom 35 (17%) required ICU admission. Median age was 58 years [IQR 41–72], with a female predominance (62%) and a median Charlson comorbidity score of 3 [1–6]. Anti‐epileptic drugs were the most frequently implicated agents (22%). Hepatic involvement was the most common visceral manifestation (70%), followed by renal (30%), haemodynamic (6.3%), cardiac (5.3%) and pulmonary involvement (1.9%). Disease severity was classified as mild in 40%, moderate in 35% and severe in 25% of cases. Nearly, all patients received corticosteroids, predominantly topical in mild to moderate forms and systemic in severe cases. Overall, in‐hospital mortality was 4.8% ( n = 10), rising to 20% ( n = 7) among ICU patients. In multivariable analysis, hospital‐acquired DRESS (adjusted odds ratio, aOR = 5.21; 95% CI [1.96; 14.1]; p = 0.001) and DRESS severity were independently associated with ICU admission (moderate forms: aOR = 3.74 [1.13; 14.9] and severe forms: aOR = 12.5 [3.79; 51.3], versus minor forms; p < 0.001). Conclusions: Nearly one in five hospitalized patients with DRESS required ICU management. Hospital‐acquired DRESS and disease severity were the main determinants of critical care admission, underscoring their prognostic importance.

La reconnaissance des antigènes du soi et du non soi par les lymphocytes B et T est à l'origine des maladies auto-immunes et inflammatoires. Les anticorps et les auto-anticorps produits par les plasmocytes dérivés des lymphocytes B sont utiles à des fins diagnostiques, mais contribuent également à la physiopathologie de ces maladies. La déplétion des lymphocytes B au cours des maladies auto-immunes chez l'homme a recentré l'attention sur les rôles des lymphocytes B comme modulateurs de la fonction des lymphocytes T, en plus de leur rôle de cellules productrices d'anticorps. L'utilisation d'anticorps anti-CD20 chez la souris révèle le rôle fondamental des lymphocytes B comme adjuvants cellulaires pour l'activation des lymphocytes T CD4+ in vivo (lymphocytes B effecteurs) mais également le rôle régulateur inattendu d'une sous-population de lymphocytes B spléniques CD1dhighCD5+ qui produit de l'interleukine 10 (lymphocytes B10). Le rôle de ces lymphocytes B effecteurs est montré dans un modèle chez la souris NOD (Non Obese Diabetic) alors que le rôle des lymphocytes B régulateurs est montré dans un modèle murin d'eczéma de contact. Au cours de l'encéphalite auto-immune expérimentale, la déplétion précoce des lymphocytes B aggrave les signes neurologiques tandis que la déplétion tardive des lymphocytes B les améliore, reflétant la dualité fonctionnelle des lymphocytes B au cours des maladies inflammatoires