Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but serious delayed hypersensitivity reaction that can be caused by antibiotic exposure. The reaction typically develops in 2 to 6 weeks. The pathophysiology is thought to involve toxic drug metabolites acting as a hapten, triggering a systemic response. The diagnosis is made clinically but can be confirmed using assays such as the lymphocyte toxicity assay (LTA), which correlates cell death upon exposure to drug metabolites with susceptibility to hypersensitivity reactions. Case 1 involves a previously healthy 11-month-old male with first exposure to amoxicillin-clavulanate, prescribed for seven days to treat a respiratory infection. The patient developed DRESS fourteen days after starting the drug and was successfully treated with corticosteroids. LTA testing confirmed patient susceptibility to hypersensitivity reactions with amoxicillin-clavulanate. Parental samples were also tested, showing both maternal and paternal susceptibility. Neither parent reported prior hypersensitivity reactions. Lifelong penicillin avoidance for the patient was advised along with the notation in medical records of penicillin allergy. The parents were advised to avoid penicillin class antibiotics and be monitored closely for DRESS if they are exposed. Case 2 involves an 11-year-old female with atopic dermatitis with first exposure to amoxicillin-clavulanate, prescribed for ten days to treat a secondary bacterial skin infection. She developed DRESS eleven days after starting antibiotics and was successfully treated with corticosteroids. LTA testing confirmed patient susceptibility to hypersensitivity reactions with amoxicillin-clavulanate. Maternal samples were also tested and showed sensitivity. The mother reported no prior hypersensitivity reactions. Lifelong penicillin avoidance for the patient was advised along with the notation in medical records of penicillin allergy. Amoxicillin-clavulanate is a commonly used antibiotic and the cases we have described suggest that it should be recognized as a potential cause of DRESS in pediatric patients. Furthermore, these cases contribute to current literature supporting that there may be a shorter latent period in DRESS induced by antibiotics. We have also shown that the LTA can be a helpful tool to confirm DRESS reactions, and that testing may have potential implications for family members.

中文翻译：

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淋巴细胞毒性试验证实阿莫西林-克拉维酸诱导的两例小儿DRESS

嗜酸性粒细胞增多和全身症状（DRESS）的药物反应是罕见的但严重的迟发型超敏反应，可能是由于抗生素暴露引起的。该反应通常在2至6周内发展。据认为，病理生理学涉及作为半抗原的有毒药物代谢物，引发全身性反应。该诊断是在临床上进行的，但可以使用诸如淋巴细胞毒性试验（LTA）之类的试验加以证实，该试验将暴露于药物代谢产物时的细胞死亡与对超敏反应的敏感性相关联。病例1涉及一个先前健康的11个月大男性，他第一次接触阿莫西林-克拉维酸盐，开处方7天以治疗呼吸道感染。该患者在开始用药后十四天出现了DRESS，并成功接受了皮质类固醇激素治疗。LTA测试证实了患者对阿莫西林-克拉维酸盐过敏反应的敏感性。还对父母样品进行了测试，显示出母体和父体的药敏性。父母双方均未报告过过敏反应。建议患者终生避免使用青霉素，并在病历中注明青霉素过敏。建议父母避免使用青霉素类抗生素，如果暴露，则应严密监测DRESS。案例2涉及一名11岁的女性，患有特应性皮炎，首次接触阿莫西林-克拉维酸盐，开处方10天即可治疗继发性细菌性皮肤感染。在开始使用抗生素十一天后，她出现了DRESS，并成功接受了皮质类固醇激素治疗。LTA测试证实了患者对阿莫西林-克拉维酸盐过敏反应的敏感性。孕产妇样品也进行了测试，并显示出敏感性。母亲没有报道过过敏反应。建议患者终生避免使用青霉素，并在病历中注明青霉素过敏。阿莫西林-克拉维酸盐是一种常用的抗生素，我们描述的病例表明，它应被认为是小儿患者DRESS的潜在病因。此外，这些病例有助于目前的文献，支持由抗生素诱导的DRESS的潜伏期较短。我们还表明，LTA可以作为确认DRESS反应的有用工具，并且测试可能会对家庭成员产生潜在影响。孕产妇样品也进行了测试，并显示出敏感性。这位母亲没有报道过过敏反应。建议患者终生避免使用青霉素，并在病历中注明青霉素过敏。阿莫西林-克拉维酸盐是一种常用的抗生素，我们描述的病例表明，它应被认为是小儿患者DRESS的潜在病因。此外，这些病例有助于目前的文献，支持由抗生素诱导的DRESS的潜伏期较短。我们还表明，LTA可以作为确认DRESS反应的有用工具，并且测试可能会对家庭成员产生潜在影响。孕产妇样品也进行了测试，并显示出敏感性。母亲没有报道过过敏反应。建议患者终生避免使用青霉素，并在病历中注明青霉素过敏。阿莫西林-克拉维酸盐是一种常用的抗生素，我们描述的病例表明，它应被认为是小儿患者DRESS的潜在病因。此外，这些病例有助于目前的文献，支持由抗生素诱导的DRESS的潜伏期较短。我们还表明，LTA可以作为确认DRESS反应的有用工具，并且测试可能会对家庭成员产生潜在影响。建议患者终生避免使用青霉素，并在病历中注明青霉素过敏。阿莫西林-克拉维酸盐是一种常用的抗生素，我们描述的病例表明，它应被认为是小儿患者DRESS的潜在病因。此外，这些病例有助于目前的文献，支持由抗生素诱导的DRESS的潜伏期较短。我们还表明，LTA可以作为确认DRESS反应的有用工具，并且测试可能会对家庭成员产生潜在影响。建议患者终生避免使用青霉素，并在病历中注明青霉素过敏。阿莫西林-克拉维酸盐是一种常用的抗生素，我们描述的病例表明，它应被认为是小儿患者DRESS的潜在病因。此外，这些病例有助于目前的文献，支持由抗生素诱导的DRESS的潜伏期较短。我们还表明，LTA可以作为确认DRESS反应的有用工具，并且测试可能会对家庭成员产生潜在影响。这些病例为目前的文献做出了贡献，这些文献支持抗生素诱导的DRESS潜伏期较短。我们还表明，LTA可以作为确认DRESS反应的有用工具，并且测试可能会对家庭成员产生潜在影响。这些病例为目前的文献做出了贡献，这些文献支持抗生素诱导的DRESS潜伏期较短。我们还表明，LTA可以作为确认DRESS反应的有用工具，并且测试可能会对家庭成员产生潜在影响。