Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) caused by niraparib: a novel antineoplastic agent

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare but potentially life-threatening hypersensitivity reaction characterized by skin rash, fever, lymphadenopathy, hematologic abnormalities, and organ involvement. Niraparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, is used to treat ovarian, fallopian tube, or primary peritoneal cancer. Although niraparib is associated with cutaneous toxicities, no severe cutaneous adverse reactions (SCARs) have been reported until now.

We present a case of DRESS syndrome in a 73-year-old woman with high-grade serous ovarian cancer treated with niraparib. After 20 days of therapy, she developed a widespread maculopapular rash. Despite discontinuation of niraparib and treatment with corticosteroids, she exhibited pruritus, facial edema, lymphadenopathy, eosinophilia, and impaired liver and renal function. A RegiSCAR score of 6 confirmed the diagnosis of DRESS. Patch testing to niraparib 1% in DMSO was positive when performed nine weeks after DRESS resolution.

This is the first reported case of DRESS by hypersensitivity due to niraparib. This case highlights the importance of recognizing DRESS as a potential adverse reaction to niraparib and the efficacy of early corticosteroid intervention. Further research is needed to understand and mitigate the risk.