Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) With Eosinophilic Cholecystitis Triggered by Topical Diclofenac

Rebecca K. Tsevat; Olivia Fisher; Danielle G. Tsevat; Erika Brigmon; Christopher Crane; Anthony Hartzler; Emily M. Becker; Edward G. Brooks; Supreet Kaur; Joel Tsevat

doi:10.7326/aimcc.2023.0611

Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) With Eosinophilic Cholecystitis Triggered by Topical Diclofenac

Rebecca K. Tsevat, Olivia Fisher, Danielle G. Tsevat, Erika Brigmon, Christopher Crane, Anthony Hartzler, Emily M. Becker, Edward G. Brooks, Supreet Kaur, Joel Tsevat

Research output: Contribution to journal › Article › peer-review

Abstract

A 64-year-old man presented with a diffuse rash accompanied by abdominal fullness and anorexia. Two and a half weeks earlier, he injured his foot and began applying topical 1% diclofenac gel several times a day. His clinical course was notable for fever, an absolute eosinophil count of 7.49 × 10⁹ cells/L, transaminitis, and eosinophilic cholecystitis. An extensive work-up for other causes of eosinophilia was negative, and the patient met clinical criteria for drug reaction with eosinophilia and systemic symptoms (DRESS). His symptoms and laboratory abnormalities gradually improved without corticosteroid treatment. This represents, to our knowledge, the first case of DRESS triggered by topical diclofenac.

Original language	English (US)
Article number	e230611
Journal	Annals of Internal Medicine Clinical Cases
Volume	2
Issue number	12
DOIs	https://doi.org/10.7326/aimcc.2023.0611
State	Published - Dec 2023

Keywords

Adverse reactions
Allergy and immunology
Cholecystitis
DRESS
Eosinophilia
Eosinophilic cholecystitis
Eosinophils
Gallbladder
NSAIDs
Pemphigus
Rashes
Skin
Topical diclofenac

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Internal Medicine
Clinical Biochemistry

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10.7326/aimcc.2023.0611

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Tsevat, R. K., Fisher, O., Tsevat, D. G., Brigmon, E., Crane, C., Hartzler, A., Becker, E. M., Brooks, E. G., Kaur, S., & Tsevat, J. (2023). Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) With Eosinophilic Cholecystitis Triggered by Topical Diclofenac. Annals of Internal Medicine Clinical Cases, 2(12), Article e230611. https://doi.org/10.7326/aimcc.2023.0611

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title = "Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) With Eosinophilic Cholecystitis Triggered by Topical Diclofenac",

abstract = "A 64-year-old man presented with a diffuse rash accompanied by abdominal fullness and anorexia. Two and a half weeks earlier, he injured his foot and began applying topical 1% diclofenac gel several times a day. His clinical course was notable for fever, an absolute eosinophil count of 7.49 × 109 cells/L, transaminitis, and eosinophilic cholecystitis. An extensive work-up for other causes of eosinophilia was negative, and the patient met clinical criteria for drug reaction with eosinophilia and systemic symptoms (DRESS). His symptoms and laboratory abnormalities gradually improved without corticosteroid treatment. This represents, to our knowledge, the first case of DRESS triggered by topical diclofenac.",

keywords = "Adverse reactions, Allergy and immunology, Cholecystitis, DRESS, Eosinophilia, Eosinophilic cholecystitis, Eosinophils, Gallbladder, NSAIDs, Pemphigus, Rashes, Skin, Topical diclofenac",

author = "Tsevat, {Rebecca K.} and Olivia Fisher and Tsevat, {Danielle G.} and Erika Brigmon and Christopher Crane and Anthony Hartzler and Becker, {Emily M.} and Brooks, {Edward G.} and Supreet Kaur and Joel Tsevat",

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year = "2023",

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doi = "10.7326/aimcc.2023.0611",

language = "English (US)",

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AU - Fisher, Olivia

AU - Tsevat, Danielle G.

AU - Brigmon, Erika

AU - Crane, Christopher

AU - Hartzler, Anthony

AU - Becker, Emily M.

AU - Brooks, Edward G.

AU - Kaur, Supreet

AU - Tsevat, Joel

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AB - A 64-year-old man presented with a diffuse rash accompanied by abdominal fullness and anorexia. Two and a half weeks earlier, he injured his foot and began applying topical 1% diclofenac gel several times a day. His clinical course was notable for fever, an absolute eosinophil count of 7.49 × 109 cells/L, transaminitis, and eosinophilic cholecystitis. An extensive work-up for other causes of eosinophilia was negative, and the patient met clinical criteria for drug reaction with eosinophilia and systemic symptoms (DRESS). His symptoms and laboratory abnormalities gradually improved without corticosteroid treatment. This represents, to our knowledge, the first case of DRESS triggered by topical diclofenac.

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Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) With Eosinophilic Cholecystitis Triggered by Topical Diclofenac

Abstract

Keywords

ASJC Scopus subject areas

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