A Rare Case of TMP-SMX Induced DRESS and Clinical TSS in a Pediatric Patient

Abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare and potentially life-threatening adverse drug reaction. We present a case of a 14-year-old girl with overlapping DRESS syndrome and Toxic Shock Syndrome (TSS) following Trimethoprim/Sulfamethoxazole treatment. The patient developed a generalized pruritic maculopapular rash, lymphadenopathy, fever, and facial swelling. Laboratory results showed leukocytosis, elevated liver enzymes, and C-reactive protein (CRP). Despite initial treatment with methylprednisolone, her condition worsened, necessitating a transfer to a higher level of care. She exhibited fever, hypotension, tachycardia, tachypnea, strawberry tongue, and perioral impetigo, consistent with TSS. Antibiotic therapy was initiated, but eosinophilia and an abdominal desquamative rash emerged, indicative of DRESS syndrome. Treatment involved discontinuing antibiotics, administering intravenous solumedrol for possible DRESS, and restarting antibiotics due to persistent TSS features. The patient’s symptoms improved, and she was discharged on tapering steroids and antibiotics. This case highlights the coexistence of DRESS and TSS in a pediatric patient and emphasizes the importance of promptly discontinuing the offending agent and appropriate management with steroids and antibiotics. Of the participants, 65.9% reported decreased activity levels, while 46.3% experienced weight gain. Notably, 64.2% of participants had an elevated risk score, signifying an increased vulnerability to T2D.