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<p>Drug-induced hypersensitivity syndrome (DIHS) is a potentially life-threatening reaction. The pathology of DIHS has been connected with adverse reactions to drugs; however, it has been observed that viruses and other infectious factors may induce similar responses in the body. COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently become a major challenge for worldwide healthcare. The dermatological symptoms occur in approximately 5.95% of COVID-19 patients, however, they are not exclusively a manifestation of SARS-CoV-2 infection.</p>
<p>Certain skin-related symptoms might result from therapeutic drug administration, personal protective equipment, or sanitizers used by medical personnel. The complex pathomechanism of those symptoms leads to multiple diagnostic difficulties. This article describes a case of a 40-year-old man who was admitted to the intensive care unit (ICU) due to heavy respiratory failure in the course of SARS-CoV-2 infection. The patient has been treated with olanzapine for anxiety disorder for approximately 4 years. On the seventh day of treatment, the patient presented with a maculopapular rash, fever, and swollen upper lip. Because of these presented symptoms, the patient has been diagnosed with drug-induced hypersensitivity syndrome (DIHS). The results of blood analysis showed elevated levels of acute phase markers, liver and kidney damage markers, which are present both during COVID-19 and DIHS. Furthermore, the patient presented with peripheral eosinophilia, which is a distinctive feature of DIHS. In the course of COVID-19, the laboratory-measured levels of eosinophilic granulocytes declined to 0. Therefore, in the active phase of SARS-CoV-2 infection, the eosinophilia connected with DIHS was difficult to assess. In this paper, we compare and contrast the clinical and laboratory symptoms of COVID-19 and DIHS syndrome, describe patient's case and explain the diagnostics difficulties resulting from the concomitance of those disease entities.</p>
</abstract>

Drug-induced hypersensitivity syndrome (DIHS) is a potentially life-threatening reaction. The pathology of DIHS has been connected with adverse reactions to drugs; however, it has been observed that viruses and other infectious factors may induce similar responses in the body. COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently become a major challenge for worldwide healthcare. The dermatological symptoms occur in approximately 5.95% of COVID-19 patients, however, they are not exclusively a manifestation of SARS-CoV-2 infection.
Certain skin-related symptoms might result from therapeutic drug administration, personal protective equipment, or sanitizers used by medical personnel. The complex pathomechanism of those symptoms leads to multiple diagnostic difficulties. This article describes a case of a 40-year-old man who was admitted to the intensive care unit (ICU) due to heavy respiratory failure in the course of SARS-CoV-2 infection. The patient has been treated with olanzapine for anxiety disorder for approximately 4 years. On the seventh day of treatment, the patient presented with a maculopapular rash, fever, and swollen upper lip. Because of these presented symptoms, the patient has been diagnosed with drug-induced hypersensitivity syndrome (DIHS). The results of blood analysis showed elevated levels of acute phase markers, liver and kidney damage markers, which are present both during COVID-19 and DIHS. Furthermore, the patient presented with peripheral eosinophilia, which is a distinctive feature of DIHS. In the course of COVID-19, the laboratory-measured levels of eosinophilic granulocytes declined to 0. Therefore, in the active phase of SARS-CoV-2 infection, the eosinophilia connected with DIHS was difficult to assess. In this paper, we compare and contrast the clinical and laboratory symptoms of COVID-19 and DIHS syndrome, describe patient's case and explain the diagnostics difficulties resulting from the concomitance of those disease entities.

A patient infected with SARS-Cov-2 presents with DIHS syndrome induced by olanzapine: diagnostic difficulties

Medical University of Lublin: Uniwersytet Medyczny w Lublinie

Postępy Higieny i Medycyny Doświadczalnej

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Drug-induced hypersensitivity syndrome (DIHS) is a potentially life-threatening reaction. The pathology of DIHS has been connected with adverse reactions to...

Days of hospitalization
	7	9	10	11	13	14
Parameter value in PB
Leukocytes [10³ /μl]	9.77	7.47	6.03	9.38	5.9	6.27
Neutrophils [%]	82.7	62.1	84.1	79	57.4	62.4
Eosinophils [%]	1.6	12	2	1.5	13.4	8.8
Basophils [%]	0.2	0.8	0	0.2	1	0.6
Lymphocytes [%]	12	15.3	9.1	15.4	21.5	21.5
Monocytes [%]	3.4	9.8	4.8	3.9	9.7	6.7
Erythrocytes [10⁶ /μl]	4	3.5	3	3.2	3.5	3.6
Hemoglobin [g/dl]	11.2	10.4	8.5	9.3	10.1	10.3
Hematocrit [%]	34.3	31.4	25.7	27.3	30.1	29.8
MCV [10⁻¹⁵ /μl]	86.4	89	85.7	84.5	87	83.5
MCH [pg/cell]	28.2	29.5	28.3	28.8	29.2	28.9
MCHC [g/dl]	32.7	33.1	33.1	34.1	33.6	34.6
RDW-CV [%]	12.9	14.9	13	13	14.1	13.8
PLT [10⁻¹⁵ /μl]	310	365	181	228	305	322
MPV [10⁻¹⁵ /μl]	11	11	12.7	12.9	10.6	10.9
AspAT [U/l]	87			64
AlAT [U/l]	109			97
CRP [mg/l]	89.5	8.13	73.2	131	19.1	21.4
CK [U/l]				1144

A patient infected with SARS-Cov-2 presents with DIHS syndrome induced by olanzapine: diagnostic difficulties

Article Category: Review

Publicado en línea: 08 oct 2023

Páginas: 99 - 106

Recibido: 12 mar 2023

Aceptado: 10 ago 2023

DOI: https://doi.org/10.2478/ahem-2023-0016

Palabras clave
drug-induced hypersensitivity syndrome, drug reaction with eosinophilia and systemic symptoms COVID-19, olanzapine

© 2023 Michalina Pinkosz et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

A detailed description of patient's blood morphology throughout the treatment process and additional key symptoms observed in the process

A patient infected with SARS-Cov-2 presents with DIHS syndrome induced by olanzapine: diagnostic difficulties

Article Category: Review

Publicado en línea: 08 oct 2023

Páginas: 99 - 106

Recibido: 12 mar 2023

Aceptado: 10 ago 2023

DOI: https://doi.org/10.2478/ahem-2023-0016

Palabras clavedrug-induced hypersensitivity syndrome, drug reaction with eosinophilia and systemic symptoms COVID-19, olanzapine

© 2023 Michalina Pinkosz et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

A detailed description of patient's blood morphology throughout the treatment process and additional key symptoms observed in the process

Palabras clave
drug-induced hypersensitivity syndrome, drug reaction with eosinophilia and systemic symptoms COVID-19, olanzapine