Fatal Case of Pneumocystis Jirovecii Pneumonia (PJP) During Treatment for Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome

Figures & data

Figure 1 The main timeline for diagnosis and treatment characteristics associated with DRESS syndrome.

Table 1 RegiSCAR DRESS Validation Score 2007 [9]

Score	−1	0	1	2	MIN	MAX	Patients’ value
Fever > 38.5 °C (core) or >38°C (axillar)	N	Y			−1	0	0
Enlarged lymph nodes (>1 cm size, at least two sites)		N/U	Y		0	1	1
Eosinophilia		N/U	0.7–1.499×10^9/L 10–19.9% (if leucopenia)	>1.5×10^9/L >20% (if leucopenia)	0	2	2
Atypical Lymphocytes		N/U	Y		0	1	1
Skin involvement					−2	2	2
- Rash extent (%)		N/U	>50%
- Rash suggesting DRESS (≥2 of facial edema, purpura, infiltration, desquamation)	N	U	Y
- Biopsy suggesting DRESS	N	Y/U
Organ involvement L/K/Lu/M-H/Pa/Other		N/U	Y/Y/Y/Y/Y/Y*		0	2	1
Resolution> 15 days	N	Y			−1	0	0
Evaluation of other potential causes: Serology for HAV/HBV/HCV; blood culture; Antinuclear antibody; Chlamydia/Mycoplasma			Y (None (+) and at least 3 (-)		0	1	0
Total score^#	<2: Excluded; 2–3: Possible; 4–5 Probable; > 5 Definite				−4	9	7

Notes: (N) No, (Y) Yes, (U) Unknown, (L) Liver, (K) Kidney, (Lu) Lung, M (Muscle), H (Heart) (Pa) Pancreas, (HAV) hepatitis A virus, (HBV) hepatitis B virus, (HCV) hepatitis C virus, *After exclusion of other explanations, 1, one organ; 2, two or more organs. ^#Final score <2, no case; final score 2–3; possible case; final score 4–5, probable case; final score> 5, definite case.

Figure 2 Changes in important laboratory indicators during hospitalization.

Figure 3 Computed tomography (CT) scan of the chest from different dates. Day 12, Right lung middle lobe and part of the lower lobe of lung atelectasis, both lungs can see calcification and cords; Day 64, Diffuse bilateral ground-glass opacities with mild interstitial changes; Day 75, Diffuse bilateral ground-glass opacities with the thickening of interlobular interval, exudation in both lungs increased significantly compared to previous (Day 64), considering the possibility of interstitial pneumonia; Day 79, Diffuse bilateral ground-glass opacities with the thickening of interlobular interval, multiple bronchiectasis of both lower lungs. The exudation of the upper lobe of the left lung was less than before (Day 75).

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.