{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T20:56:46Z","timestamp":1760648206962,"version":"build-2065373602"},"reference-count":10,"publisher":"Colegio Mexicano de Inmunologia Clinica y Alergia, A. C.","issue":"3","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["revistaalergia.mx"],"crossmark-restriction":false},"short-container-title":["Rev. Alergia Mex"],"published-print":{"date-parts":[[2025,9,30]]},"abstract":"<jats:p>Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction. The incidence is 1-1,000,000 with a mortality rate of 3.8-10%, and it is a disease associated with reactivation of the herpes simplex virus.\n\nCase report: A 34-year-old woman with atopy and venous insufficiency presented with pruritic hives on her face and arms, which progressed to a morbilliform rash, facial edema, fever, lymphadenopathy, and scaling. A complete blood count showed no abnormalities: AST: 837 U\/L, ALT: 11352 U\/L. Due to the suspicion of DRESS syndrome, treatment with corticosteroids was initiated and a biopsy was obtained. Upon questioning, the patient reported having taken diosmin-hesperidin and undergone systemic sunscreen (Heliocare360\u00b0\u00ae) 21 days prior to the onset of the rash. Histopathological examination revealed atrophic epidermis, vacuolar degeneration, and inflammatory infiltrate. Systemic corticosteroids were administered for three weeks, with a satisfactory response. Two months later, the patient experienced reactivation of the dermatosis and hypertransaminasemia; the autoantibody panel and serology were positive for IgM for herpes simplex virus.\n\nConclusion: This case underscores the need to consider severe hypersensitivity reactions, even with commonly used and apparently low-risk drugs. The importance of a comprehensive approach, including identification of the suspected medication, exclusion of differential diagnoses, prolonged clinical follow-up, and surveillance for possible viral reactivation, is emphasized.\n\nKeywords: DRESS syndrome; Incidence; Herpes simplex virus; Lymphadenopathy; Diosmine-herperidin; Rash; Corticosteroids; IgM.<\/jats:p>","DOI":"10.29262\/ram.v72i3.1502","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T14:11:12Z","timestamp":1759241472000},"page":"205-208","update-policy":"https:\/\/doi.org\/10.29262\/ram.crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Diosmin-hesperidin-induced DRESS syndrome: immune reactivation by herpesvirus"],"prefix":"10.29262","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1922-6917","authenticated-orcid":false,"given":"Nataly","family":"Flores Garcia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"11808","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"64303","doi-asserted-by":"crossref","unstructured":"1. Hama N, Abe R, Gibson A, Phillips EJ. Drug-Induced Hypersensitivity Syndrome (DIHS)\/Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): Clinical Features and Pathogenesis. Journal of Allergy and Clinical Immunology: In Practice 2022 1; 10 (5): 1155-1167.e5.","DOI":"10.1016\/j.jaip.2022.02.004"},{"key":"64304","doi-asserted-by":"crossref","unstructured":"2. Calle AM, Aguirre N, Ardila JC, Cardona-Villa R. DRESS syndrome: A literature review and treatment algorithm. Vol. 16, World Allergy Organization J Elsevier Inc; 2023.","DOI":"10.1016\/j.waojou.2022.100673"},{"key":"64305","doi-asserted-by":"crossref","unstructured":"3. Ramirez GA, Ripa M, Burastero S, Benanti G, Bagnasco D, et al. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses. Microorganisms 2023; 11 (2): 346.","DOI":"10.3390\/microorganisms11020346"},{"key":"64306","doi-asserted-by":"crossref","unstructured":"4. Gerges SH, Wahdan SA, Elsherbiny DA, El-Demerdash E. Pharmacology of Diosmin, a Citrus Flavone Glycoside: An Updated Review. Eur J Drug Metab Pharmacokinet 2022; 47 (1): 1-18.","DOI":"10.1007\/s13318-021-00731-y"},{"key":"64307","unstructured":"5. Segars K, McCarver V, Miller RA. Dermatologic Applications of Polypodium leucotomos: A Literature Review. J Clin Aesthet Dermatol 2021; 14 (2): 50-60. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/34221229"},{"key":"64308","doi-asserted-by":"crossref","unstructured":"6. Pav\u00f3n-Romero GF, Guti\u00e9rrez-Quiroz KV, Ram\u00edrez-Jim\u00e9nez F, Rosas-Fern\u00e1ndez R, et al. DRESS, una reacci\u00f3n al\u00e9rgica no mediada por IgE. Rev Fac Med 2023 10; 66 (2): 7-19.","DOI":"10.22201\/fm.24484865e.2023.66.2.02"},{"key":"64309","doi-asserted-by":"crossref","unstructured":"7. Kardaun SH, Sekula P, Valeyrie-Allanore L, Liss Y, Chu CY, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): An original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol 2013; 169 (5): 1071-80.","DOI":"10.1111\/bjd.12501"},{"key":"64310","unstructured":"8. Awad N, Hetzel JD, Bhupalam V, Nestor MS. Stasis Dermatitis: Pathophysiology, Current Treatment Paradigms, and the Use of the Flavonoid Diosmin. J Clin Aesthet Dermatol 2024; 17 (1): 15-23. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/38298753"},{"key":"64311","doi-asserted-by":"crossref","unstructured":"9. Palakornkitti P, Rattananukrom T. Drug Reaction with Eosinophilia and Systemic Symptoms Induced by Diosmin and Hesperidin: A Case Report. Clinical, Cosmetic and Investigational Dermatology 2024; 17: 1127-32.","DOI":"10.2147\/CCID.S464672"},{"key":"64312","doi-asserted-by":"crossref","unstructured":"10. Barbaud A, Goncalo M, Mockenhaupt M, Copaescu A, et al. Delayed Skin Testing for Systemic Medications: Helpful or Not? J Allergy Clin Immunol Pract 2024; 12 (9): 2268-77.","DOI":"10.1016\/j.jaip.2024.06.047"}],"container-title":["Revista Alergia M\u00e9xico"],"original-title":[],"link":[{"URL":"https:\/\/revistaalergia.mx\/ojs\/index.php\/ram\/article\/download\/1502\/2750","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/revistaalergia.mx\/ojs\/index.php\/ram\/article\/download\/1502\/2750","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T04:16:29Z","timestamp":1759551389000},"score":1,"resource":{"primary":{"URL":"https:\/\/revistaalergia.mx\/ojs\/index.php\/ram\/article\/view\/1502"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":10,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9,30]]},"published-print":{"date-parts":[[2025,9,30]]}},"URL":"https:\/\/doi.org\/10.29262\/ram.v72i3.1502","relation":{},"ISSN":["0002-5151","2448-9190"],"issn-type":[{"type":"print","value":"0002-5151"},{"type":"electronic","value":"2448-9190"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}