{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:49:02Z","timestamp":1784202542515,"version":"3.55.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Drug-induced hypersensitivity syndrome (DIHS), also known as drug reaction with eosinophilia and systemic symptoms (DRESS), is a rare but potentially life-threatening adverse drug reaction. Clopidogrel induced DHS following percutaneous coronary intervention (PCI) presents a unique therapeutic challenge due to the critical need for dual antiplatelet therapy to prevent stent thrombosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 70-year-old male underwent emergency PCI with multiple stent implantation for unstable angina with three-vessel coronary disease. Standard dual antiplatelet therapy (aspirin 100\u00a0mg daily and clopidogrel 75\u00a0mg daily) was initiated post-procedure. One hour after PCI, the patient developed anaphylactic shock initially attributed to contrast agent allergy. Two weeks post-discharge, he presented with recurrent skin rash, hypotension, gastrointestinal bleeding, fever, and eosinophilia, consistent with DIHS. Multidisciplinary consultation confirmed clopidogrel-induced DIHS using established diagnostic criteria. Despite the high risk of stent thrombosis, dual antiplatelet therapy was discontinued due to life-threatening complications. The patient was successfully managed with indobufen and low dose corticosteroids, resulting in complete symptom resolution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the diagnostic complexity of clopidogrel-induced DIHS and presents the detailed account of successful management of it. Early recognition using standardized diagnostic criteria and multidisciplinary management are crucial for patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2025.1695177","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T05:22:08Z","timestamp":1770700928000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Clopidogrel-induced drug-induced hypersensitivity syndrome following percutaneous coronary intervention: a case report of therapeutic dilemma and management strategy"],"prefix":"10.3389","volume":"16","author":[{"given":"Sikun","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine","place":["Shiyan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taihe Hospital, Hubei University of Medicine","place":["Shiyan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanhua","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery, Taihe Hospital, Hubei University of Medicine","place":["Shiyan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1016\/j.amjmed.2011.01.017","article-title":"The DRESS syndrome: a literature review","volume":"124","author":"Cacoub","year":"2011","journal-title":"Am. J. Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"100673","DOI":"10.1016\/j.waojou.2022.100673","article-title":"DRESS syndrome: a literature review and treatment algorithm","volume":"16","author":"Calle","year":"2023","journal-title":"World Allergy Organ. J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1016\/j.jacc.2011.06.040","article-title":"Characterization of clopidogrel hypersensitivity reactions and management with oral steroids without clopidogrel discontinuation","volume":"58","author":"Cheema","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"51","DOI":"10.5415\/apallergy.2015.5.1.51","article-title":"Oral antiplatelet agent hypersensitivity and cross-reactivity managed by successful desensitisation","volume":"5","author":"Chin","year":"2015","journal-title":"Asia Pac. allergy"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.3390\/ijms18061243","article-title":"Drug reaction with eosinophilia and systemic symptoms (DRESS): an interplay among drugs, viruses, and immune system","volume":"18","author":"Cho","year":"2017","journal-title":"Int. J. Mol. Sci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1021\/tx400083b","article-title":"Thiolactone sulfoxides as new reactive metabolites acting as bis-electrophiles: implication in clopidogrel and prasugrel bioactivation","volume":"26","author":"Dansette","year":"2013","journal-title":"Chem. Res. Toxicol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1016\/j.jaip.2022.02.004","article-title":"Drug-Induced hypersensitivity syndrome (DIHS)\/Drug reaction with eosinophilia and systemic symptoms (DRESS): clinical features and pathogenesis","volume":"10","author":"Hama","year":"2022","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1177\/1060028014539143","article-title":"Ticagrelor use in a patient with a documented clopidogrel hypersensitivity","volume":"48","author":"Harris","year":"2014","journal-title":"Ann. Pharmacother."},{"key":"B9","doi-asserted-by":"publisher","first-page":"2126","DOI":"10.1001\/jama.293.17.2126","article-title":"Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents","volume":"293","author":"Iakovou","year":"2005","journal-title":"JAMA"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1111\/bjd.12501","article-title":"Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study","volume":"169","author":"Kardaun","year":"2013","journal-title":"Br. J. Dermatology"},{"key":"B11","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1124\/dmd.109.029132","article-title":"Identification of the human cytochrome P450 enzymes involved in the two oxidative steps in the bioactivation of clopidogrel to its pharmacologically active metabolite","volume":"38","author":"Kazui","year":"2010","journal-title":"Drug metabolism Dispos. Biol. Fate Chem."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.1016\/j.jacc.2021.09.006","article-title":"2021 ACC\/AHA\/SCAI Guideline for coronary artery revascularization: a report of the American college of Cardiology\/American Heart association joint Committee on clinical practice Guidelines","volume":"79","author":"Lawton","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e123","DOI":"10.1161\/CIR.0000000000000404","article-title":"ACC\/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease","volume":"134","author":"Levine","year":"2016","journal-title":"Circulation"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e152","DOI":"10.1002\/phar.1446","article-title":"Acute coronary syndrome antiplatelet alternatives in clopidogrel allergy","volume":"34","author":"Manchette","year":"2014","journal-title":"Pharmacotherapy"},{"key":"B15","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1056\/NEJMoa0809171","article-title":"Cytochrome p-450 polymorphisms and response to clopidogrel","volume":"360","author":"Mega","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2147","DOI":"10.3390\/ijms22042147","article-title":"Current perspective regarding the immunopathogenesis of drug-induced hypersensitivity Syndrome\/Drug reaction with eosinophilia and systemic symptoms (DIHS\/DRESS)","volume":"22","author":"Miyagawa","year":"2021","journal-title":"Int. J. Mol. Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1038\/clpt.1981.154","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","journal-title":"Clin. Pharmacol. Ther."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1111\/all.13765","article-title":"Immune pathomechanism and classification of drug hypersensitivity","volume":"74","author":"Pichler","year":"2019","journal-title":"Allergy"},{"key":"B19","doi-asserted-by":"publisher","first-page":"40","DOI":"10.4103\/idoj.idoj_196_21","article-title":"RegiSCAR DRESS (drug reaction with eosinophilia and systemic symptoms) validation scoring System and Japanese Consensus Group criteria for atypical drug-induced hypersensitivity syndrome (DiHS): a comparative analysis","volume":"13","author":"Sasidharanpillai","year":"2022","journal-title":"Indian Dermatology Online J."},{"key":"B20","doi-asserted-by":"publisher","first-page":"950719","DOI":"10.3389\/fphar.2022.950719","article-title":"Effect of indobufen vs. aspirin on platelet accumulation in patients with stable coronary heart disease after percutaneous coronary intervention: an open-label crossover study","volume":"13","author":"Shi","year":"2022","journal-title":"Front. Pharmacol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1080\/09537104.2016.1203402","article-title":"Use of prasugrel in the setting of clopidogrel hypersensitivity: case report and systematic review of the literature","volume":"27","author":"Siu","year":"2016","journal-title":"Platelets"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2622","DOI":"10.3390\/jcm13092622","article-title":"ALDRESS: a retrospective pilot Study to develop a pharmacological causality Algorithm for drug reaction with eosinophilia and systemic symptoms (DRESS)","volume":"13","author":"Stewart","year":"2024","journal-title":"J. Clin. Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/j.jaad.2023.02.072","article-title":"Drug-induced hypersensitivity syndrome\/drug reaction with eosinophilia and systemic symptoms. Part I. Epidemiology, pathogenesis, clinicopathological features, and prognosis","volume":"90","author":"Wei","year":"2024","journal-title":"J. Am. Acad. Dermatology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1124\/mol.112.079061","article-title":"Formation of the thiol conjugates and active metabolite of clopidogrel by human liver microsomes","volume":"82","author":"Zhang","year":"2012","journal-title":"Mol. Pharmacol."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1695177\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:55:15Z","timestamp":1771926915000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1695177\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":24,"alternative-id":["10.3389\/fphar.2025.1695177"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2025.1695177","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]},"article-number":"1695177"}}