Drug Rash with Eosinophilia and Systemic Symptoms Syndrome: Case Report and Literature Review

Abstract

BACKGROUND: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a rare, potentially life-threatening, drug-induced hypersensitivity reaction. This condition is characterized by a range of symptoms, including cutaneous reaction, hematologic abnormalities, lymphadenopathy, and potential involvement of internal organs. Most DRESS cases are associated with certain medications such as antiseizure drugs, allopurinol, antibacterial sulfonamides, minocycline, and vancomycin. CASE PRESENTATION: We presented a case of 70-year-old women exhibiting maculopapular rash affecting the face, abdomen, and extremities. She experienced generalized pruritus, along with ulcerative crusty lesions on the mouth and mucopurulent conjunctivitis, all of which had persisted for 1 week. She was recently diagnosed with hyperuricemia and had been undergoing treatment with allopurinol for 4 weeks. During her hospital stay, the rash intensified, and there was a worsening involvement of the mucosa in the oral and ocular area. Allopurinol was promptly discontinued, and the patient was prescribed a daily dose of 100 mg prednisolone, gradually tapering off over a 2-month period. Additionally, the treatment included anticoagulants, antibiotics, local application of mild steroid emulsions, antiseptic, and antifungal therapy for the oral mucosa. Antibiotic solutions and natural tear eye drops were used. Over the 2-month period, the rash completely resolved, and the liver enzymes returned to normal levels. CONCLUSION: DRESS syndrome is an unpredictable drug-induced reaction identified by symptoms such as rash, fever, lymphadenopathy, and potential internal organ involvement. Allopurinol is among the medications associated with this condition, particularly when there is a reduced renal clearance and simultaneous use of thiazide diuretics. Prompt withdrawal of the causative drug is the universally accepted approach to manage drug-induced hypersensitivity reactions. The use of systemic corticosteroids can reduce symptoms of delayed hypersensitivity reactions. However, the absence of randomized controlled trials leaves uncertainty about the necessity of administering steroids, sparking a controversial debate regarding their use in such cases.