A Case of DiHSS/DRESS Syndrome-Related Acute Hepatic Failure

Abstract

‘Drug Induced Hypersensitivity Syndrome’ (DiHS) or ‘Drug Rash with Eosinophilia and Systemic Symptoms’ (DRESS) syndrome is a life threatening, delayed type drug hypersensitivity reaction. This syndrome is characterized by fever, skin rash, lymphadenopathy, hematological abnormalities and visceral involvement and liver is the most frequently involved visceral organ. Liver involvement is mostly presented as acute anicteric hepatitis with elevated liver enzymes. Rarely, it can be presented as cholestasis which indicates a worse prognosis. In this article, a case of valproic acid induced-DRESS syndrome who presented with acute hepatic failure is presented. Diagnosis of DRESS syndrome may delay due to the long interval between drug intake and the onset of symptoms. The variety of symptoms can also be challenging. Early diagnosis is important in terms of reducing morbidity and mortality.