When DRESS reaches a severe presentation — marked by substantial liver injury or damage to other organ systems — its management requires a structured escalation beyond standard care. This protocol defines the approach for this high-acuity clinical scenario.
Severe DRESS is defined by severe hepatic damage — transaminases exceeding 15 times the upper limit of normal and/or Factor V below 50% — and/or acute kidney injury classified as KDIGO III, damage to other organs (lung, heart, digestive organs, central nervous system), and/or macrophage activation syndrome.
Systemic corticosteroids form the treatment foundation. Depending on the severity of organ involvement and the presence of viral reactivation, specific adjunctive therapies are added to the corticosteroid backbone. The complete structured regimen — including which adjunctive options apply and under what conditions — is available in the full protocol.
Key therapeutic goals include reduction of circulating eosinophilia and, where viral reactivation is a factor, achieving a negative viral load.