Comparison Between Corticosteroid and Topical Steroids in the DRESS

Inclusion Criteria

• •patient age ≥ 18 years
• •signing informed consent form
• •DRESS diagnosis with at least 4 criteria a, b, c, d
• •1. Skin rash occurring at least 10 days and not more than two months after continuous drug intake (or within less than 10 days in case of rechallenge)
• •2. Fever ≥ 38 ° at the time of examination or fever ≥ 38.5 ° peak in the last 72 hours (amendment 2 : ANSM + CPP : 08/04/14)
• •3. at least one visceral compatible :
• •lymphadenopathy on at least two different sites measuring at least 1 cm in diameter
• •transaminases \> 2 upper limit of normal (ULN) or alkaline phosphatise \> 3 ULN
• •lung involvement defined by hypoxemia (capillary oximetry ≤ 95%) and/or interstitial lung disease on chest radiography or scanner, in absence of other lung disease
• •myocarditis, pericarditis (ECG clinical suspicion and confirmed by echocardiography)
• •renal impairment defined as creatinine increase above the normal laboratory value associated with leucocyturia \> 1000 / mm3 or proteinuria, a Na / K ratio \>1 and Urine Cyto-bacteriology (EBCU) sterile in the absence of preexisting renal disease d) At least one of the following haematological abnormalities:
• •eosinophilia ≥ 0.7 g/l or \> 10 % absolute
• •lymphocytosis ≥ 5\*10\^9 /l
• •presence of atypical blood lymphocytes
• •Patient with moderate DRESS : defined by at least one reached as follows :
• •pulmonary: interstitial pneumonia with oxygen partial pressure in arterial blood (PaO2) 60-75 mmHg without dyspnoea at rest
• •Hepatic: transaminases ≥ 4 ULN and \< 15 ULN and/or PAL ≥5 ULN and V factor 50% (amendment 2 : ANSM + CPP : 08/04/14)
• •renal :
• •acute renal failure and organic sharp increase in the 48 hours preceding the inclusion of more of 26.4 micromol/l creatinine
• •and / or increase of 1.5 times the normal creatinine value
• •and / or decrease of oliguria of less than 0.5 ml/kg/h followed by a 6 hours
• •cord: pancytopenia (7≤Hb≤10 gr/dl and/or 50\<p\<100 G/L, 0.5\<PNN≤1.5G/l)
• •AND absence of cardiac, neurological or gastrointestinal (gut, pancreas) threatening
• •Drug withdrawal
• •Patient with health insurance (or entitled beneficiary)
• •Patient accepting the constraints of the test