Table 26.1.
Scoring system for classifying DIHS/DRESS cases as definite, probable, possible, or no case (Adopted by RegiSCAR (Register of Severe Cutaneous Adverse Reactions) [44])
| Score | −1 | 0 | 1 | 2 | Max | Min |
|---|---|---|---|---|---|---|
| Fever ≥38.5 °C | No/U | Yes | −1 | 0 | ||
| Enlarged lymph nodes | No/U | Yes | 0 | 1 | ||
| Eosinophilia: | No/ U | 0 | 2 | |||
| Eosinophils | 0.7–1.499× 2109 l−1 | ≥1.5 × 109 l−1 | ||||
| Eosinophils, IF leukocytes <4.0 × 109 l−1 | 10–19.9% | ≥20% | ||||
| Atypical lymphocytes | No/U | Yes | 0 | 1 | ||
| Skin involvement | −2 | 2 | ||||
| Skin rash extent (% body surface area) | No/U | >50% | ||||
| Skin rash suggesting DRESS | No | U | Yes | |||
| Biopsy suggesting DRESS | No | No/U | ||||
| Organ involvement*: | 0 | 2 | ||||
| Liver | No/U | Yes | ||||
| Kidney | No/U | Yes | ||||
| Muscle/heart | No/U | Yes | ||||
| Pancreas | No/U | Yes | ||||
| Other organ | No/U | Yes | ||||
| Resolution ≥15 days | No/U | Yes | −1 | 0 | ||
| Evaluation of other potential causes: | ||||||
| Antinuclear antibody (FAN) | ||||||
| Blood culture | ||||||
| Serology HAV/HBV/HCV | ||||||
| Chlamydia/mycoplasma | ||||||
| *If none positive and ≥3 of above negative | Yes | 0 | 1 | |||
| Total score | −4 | 9 |
U unknown/unclassifiable, HAV hepatitis A virus, HBV hepatitis B virus, HCV hepatitis C virus
After exclusion of other explanations: 1 one organ, 2 two or more organs. Final score <2, no case; final score 2–3, possible case; final score 4–5, probable case; final score >5, definite case*Organ involvement