Cor Vasa 2018, 60(6):e635-e637 | DOI: 10.1016/j.crvasa.2017.12.009

Late recurrence of fulminant myocarditis related to HSS/DRESS

Miguel Ardérius^a,*, Miguel Nobre Menezes^b, Tiago Marques^c, Dulce Brito^b, Ana Ortins-Pina^d, Mónica Mendes Pedro^b, Fausto Pinto^b, Fátima Veiga^b

^a Serviço de Medicina III, Centro Hospitalar Lisboa Norte (CHLN), Portugal

^b Serviço de Cardiologia, CHLN, Centro Cardiovascular da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal

^c Serviço de Doenças Infecciosas, CHLN, Lisboa, Portugal

^d Serviço de Dermatologia, CHLN, Lisboa, Portugal

Hypersensitivity Syndrome or Drug Reaction with Eosinophilia and Systemic Symptoms (HSS/DRESS) is a rare pharmacological hypersensitivity reaction that may include cardiac involvement, with high mortality and long-term heart failure.
A 28-year-old woman, two months after the diagnosis of DRESS secondary to sulfasalazine, developed fulminant eosinophilic necrotizing myocarditis. After intensive multiorgan support, recovery and cardiac function normalization were observed. Eight months later presented a recurrence with fast progression to refractory cardiogenic shock and death.
We alert to a rare and underdiagnosed pathology, with adverse prognosis, needing timely identification and treatment.

Keywords: DRESS; Drug reaction; Eosinophilia; Fulminant myocarditis; HSS; Hypersensitivity syndrome; Sulfasalazine

Received: November 1, 2017; Revised: December 14, 2017; Accepted: December 16, 2017; Published: December 1, 2018  Show citation