Case Report

Omeprazole Induced Rapid Drug Reaction with Eosinophilia, Systemic Symptoms, and Cross-Reactivity in Delayed-Type Hypersensitivity Associated with Proton-Pump Inhibitors: A Case Report and Literature Review

Table 2

Publication reporting proton pump inhibitors associated with DRESS.

ReferencePPI drugAge (year)SexOnset (day)PresentationAbnormal testsRemark

Carboni et al. [17]Esomeprazole41F20(i) Erythematous and itching skin reaction with maculopapular diffuse lesions, followed by desquamation
(ii) Fever
(i) Eosinophilia
(ii) Hepatitis
Patch tests were positive with esomeprazole, omeprazole, and pantoprazole

Barbaud et al. [18]Esomeprazole64FNANANAPatch test positive
Esomeprazole60MNANANAPatch test positive
Pantoprazole31FNANANAPatch test positive
Pantoprazole51FNANANAPatch test negative
Lansoprazole75FNANANAPatch test negative

Bourneau-Martin et al. [19]Omeprazole88F53(i) Maculopapular exanthema on the trunk and the face converging with wide patches with purpuric lesions
(ii) Fever
(iii) Lymphadenopathy
(i) Creatinine rising
(ii) Eosinophilia
(iii) Lymphocytosis
Skin biopsy: inflammatory cell infiltrate rich in neutrophils and lymphocytes

Zaiem et al. [20]Esomeprazole84F8(i) Fever
(ii) Maculopapular rash
(i) Creatinine rising
(ii) Eosinophilia
(iii) Hepatitis
Dead

Uppalapati and Koneru [21]Lansoprazole40F30(i) Pruritis
(ii) Generalized maculopapular rash
(iii) Palmar erythema
(i) Creatinine rising Eosinophilia
(ii) Hyperbilirubinemia
Skin biopsy showed perivascular inflammatory infiltrate with elevated eosinophils

Lin et al. [22]Pantoprazole (n = 2)
Esomeprazole (n = 7)
Lansoprazole (n = 1)
61.9 ± 8.0NA27.2 ± 19.1(i) Skin rash > 50% of the BSA
(ii) At least one internal organ abnormality
(iii) One blood work abnormality
(iv) Lymphadenopathy
(v) Fever > 38.5°C
(i) Atypical lymphocyte (n = 6)
(ii) Creatinine rising (n = 3)
(iii) Eosinophilia (n = 8)
(iv) Hepatitis (n = 8)
(v) Pneumonitis (n = 3)

He et al. [23]Omeprazole66F14(i) Pruritus
(ii) Desquamation
(iii) Erythema multiforme
(iv) Fever
(i) Creatinine rising
(ii) Eosinophilia
Renal biopsy: chronic tubular interstitial inflammation diffuse atrophy of the renal tubular epithelium, extensive lymphocytic infiltration of the renal interstitial, and occasionally eosinophils

Present study’s case reportOmeprazole82F4(i) Facial erythema
(ii) Facial edema
(iii) Generalized maculopapular rash
(iv) Fever
(i) Hepatitis
(ii) Eosinophilia
ELISpot to omeprazole positive

Note: PPI, proton pump inhibitor; NA, non-applicable; F, female; M, male; BSA, body surface area; ELISpot, enzyme-linked immunosorbent spot.