DRESS Syndrome: Case presentation and review

Abstract

Introduction: DRESS Syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is an uncommon condition characterized by generalized rash, fever, eosinophilia, impaired liver function and even multiorgan failure; which is triggered generally in the first two months after starting some pharmacological treatment. Case presentation: We report a 22-year-old female patient diagnosed with epilepsy two years ago, who started treatment with phenytoin 30 days prior to admission. She arrived with a history of 10 days of erythematous macules, located in upper limbs, accompanied by moderate pruritus, which progressed to a generalized pruriginous rash. She also manifested a five day fever, abdominal pain, hypotension and tachycardia. The diagnosis was made by associating the clinical manifestations, the extremely high levels of IgE and a skin biopsy; after which medications were quickly suspended and she was treated with systemic steroids, leading to a significant improvement. Discussion: The patient presented symptoms initially triggered by drugs typically associated with the syndrome, but without the expected hematologic findings. She also developed concurrent hypersensitivity to other seldom associated medications. Conclusion: Rapid suspension of causative drugs and the application of systemic steroids are the basis of this pathology’s treatment, after which there is a significant improvement. The treatment of systemic complications should be individualized according to its severity and clinical significance.