Table 2. RegiSCAR scoring system for diagnosing DRESS.
The diagnosis of DRESS syndrome is based on the total score: <2 points: no case; 2-3 points: possible case; 4-5 points: probable case; and >5 points: definite case [4]. Our patient had a RegiSCAR score of 6: 2 for peripheral blood eosinophilia of ≥1.5×109/L; 2 for skin rash, suggesting DRESS with an extent of >50% of the BSA; and 2 for organ involvement, indicating definite DRESS.
ANA: antinuclear antibody, BSA: body surface area, DRESS: drug rash with eosinophilia and systemic symptoms, HAV: hepatitis A virus, HBV: hepatitis B virus, HCV: hepatitis C virus, N: no, U: unknown, WBC: white blood cell, Y: yes
| Items | Score | Comments | ||
| -1 | 0 | 1 | ||
| Fever ≥ 38.5°C | N/U | Y | - | - |
| Enlarged lymph nodes | - | N/U | Y | >1 cm and ≥2 different areas |
| Eosinophilia ≥ 0.7×109/L or ≥10% if WBC < 4×109/L | - | N/U | Y | Score 2, when ≥ 1.5×109/L or ≥ 20% if WBC < 4×109/L |
| Atypical lymphocytosis | - | N/U | Y | - |
| Skin rash | - | Rash suggesting DRESS: ≥ 2 symptoms: purpuric lesions (other than legs), infiltration, facial edema, psoriasiform desquamation | ||
| Extent > 50% of the BSA | - | N/U | Y | |
| Rash suggesting DRESS | N | U | Y | |
| Skin biopsy suggesting DRESS | N | Y/U | - | - |
| Organ involvement | - | N | Y | Score 1 for each organ involvement, maximal score: 2 |
| Rash resolution ≥ 15 days | N/U | Y | - | - |
| Excluding other causes | - | N/U | Y | Score 1 if 3 tests of the following tests were performed and all were negative: HAV, HBV, HCV, mycoplasma, chlamydia, ANA, and blood culture |