A CASE REPORT OF DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) WITH SYSTEMIC INVOLVEMENT

Background:Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) syndrome is an uncommon butsevere idiosyncratic drug-induced hypersensitivity reaction, which is accompanied by fever, extensivecutaneous eruption, hematological abnormalities, such as eosinophilia and internal organ involvement,especially the liver. The syndrome develops normally 2-8 weeks following exposure to the offendingdrug and has high chances of morbidity and mortality unless early identified. Typical causative agentsare: antiepileptic drugs, sulfonamides, antibiotics and allopurinol.Case Presentation:We submit a case of a 19-year-old female that presented with a history of fever, chills, cough withpost-tussive vomiting, abdominal pain, and facial rash. This patient has a history of seizure disorderthat has been treated with levetiracetam during 6 years and recently started taking sulfasalazine totreat polyarthralgia. Lab-tests showed a significant eosinophilia (35 percent) and a rise in hepaticenzymes and AST (119 U/L) and ALT (190 U/L) and bilirubin levels, making it a hepaticinvolvement. The patient was rated as a probable case of DRESS syndrome according to the clinicalfindings and laboratory parameters to be used in the RegiSCAR scoring system.Management and Outcome:The potentially causing drug was immediately discontinued, and systemic corticosteroid therapy andsupportive management were conducted. The patient experienced slow clinical recovery, feverresolving, stabilization of laboratory parameters, as well as gradual improvement of the skin lesions.Conclusion:Early detection of the DRESS syndrome and early removal of the causative drug to avoid serioussystemic complications are highlighted in this case. Clinicians are advised to have a high index ofsuspicion of DRESS syndrome in patients who present with the manifestation of rash, eosinophilia,and hepatic involvement following recent exposure to high-risk drugs like sulfasalazine andantiepileptic medications.