Assessment of lymphadenopathy in patients with drug reaction and eosinophilia (DRESS): a comparative, descriptive study

Machona, Musonda Sharon

Assessment of lymphadenopathy in patients with drug reaction and eosinophilia (DRESS): a comparative, descriptive study

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Medicine

Faculty

Faculty of Health Sciences

Abstract

Background: RegiSCAR validation criteria for drug reaction with eosinophilia and systemic symptoms (DRESS) includes lymphadenopathy, a frequent feature of both tuberculosis (TB) and HIV. TB is the most common HIV-associated co-infection. Advanced HIV is associated with lymph node (LN) fibrosis. It is not clear if this negatively impacts case validation in HIV- associated DRESS. To answer this question, we designed a prospective descriptive study to assess lymphadenopathy in various combinations of comorbid HIV, TB and DRESS. Objectives: To describe the prevalence of DRESS-associated lymphadenopathy and characterize LN quality, size, and distribution in a high HIV-TB burden setting over time. Methods: We prospectively and systematically examined LN in 25 consecutive acute DRESS cases hospitalized at a South African tertiary-care centre and 10 hospitalised non-DRESS HIV-TB co-infected controls. Results: Fourteen (56%) of 25 patients were HIV-infected, with a median (IQR) CD4 count of 254 (66-478) cells/mm3 and 7 of 14 were co-infected with TB. Using RegiSCAR criteria, 12 of 25 (46%) were definite DRESS cases, 8 (31%) of 25 were probable and 5 (23%) of 25 were possible. Possible cases were excluded in the analysis. (75%) of 20 subjects had LN in ≥2 2 anatomical sites, including 7 patients with HIV/TB co-infection. In contrast, 1 (20%) of 5 hospitalised non-DRESS HIV/TB co-infected controls had LN. Cervical LN in 15 (88%) of 17, was most common, followed by axillary (76%) and inguinal (59%). Cervical LN ranged between 1 and 2 cm in size. Amongst the 8 (40%) of 20 patients with follow-up data, LN had regressed in all within 6 weeks of stopping the offending drug and initiating TB treatment. There was no correlation with CD4 cell count and LN. Conclusion: Lymphadenopathy is a common feature of acute DRESS even among HIV-TB-co-infected patients with advanced immunosuppression.