Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal adverse drug reaction. It can be difficult to diagnose, even more so among children, since symptoms may mimic other commonly encountered pediatric conditions.
To describe clinical and laboratory features of DRESS syndrome in the pediatric population (≤ 18 years of age), establish causative agents and treatment modalities.
Multicenter retrospective study of probable and definite DRESS cases (RegiSCAR ≥ 4) in children hospitalized in 15 French University Hospitals between 2000 and 2020.
We included 49 cases. All children had fever and rash, 69.4% had lymphadenopathy and 65.3% had facial edema. The most common organ affected was the liver (83.7%). Treatment consisted in topical corticosteroid only for 30.6%, systemic corticosteroid for 55.1%; 12.2 % received IVIg. Among culprit drugs of probable and certain probability, 65% were antibiotics and 27.5% antiepileptics, with a median time to DRESS symptom onset after initiation of 15 days (13 days with antibiotics and 21 days with antiepileptics). Twenty-seven children had allergy assessment for causative agents: 65.4% had positive tests.
The culprit drugs are frequently antibiotics and antiepileptic drugs and onset is often less than two weeks after the treatment starts, especially with antibiotics. Treatment with topical corticosteroids appears sufficient in the least severe cases. Treatment by systemic corticosteroid therapy remains the reference treatment in case of severe organ damage.

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