Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially life-threatening hypersensitivity reaction with cutaneous presentation and internal organ involvement. We herein present a case of phenytoin induced DRESS syndrome in a 56- year-old male who presented with high-grade fever and chills, cough with expectoration and generalized maculopapular rash. Laboratory findings revealed eosinophilia, leukocytosis, thrombocytopenia, transaminitis and elevated inflammatory markers. Further clinical, radiological and histopathological assessments confirmed the diagnosis. Phenytoin was discontinued, and patient was started on intravenous dexamethasone, which was later switched to oral prednisone. Rapid resolution of fever, eosinophilia and progressive improvement in skin rash and liver dysfunction was observed. Our report highlights the importance of prompt recognition of DRESS syndrome and the need for a guideline directed therapy for the management of this adverse drug reaction.

Allopurinol-induced DRESS Syndrome or Drug Rash with Eosinophilia and Systemic Symptom is a rare but potentially fatal drug reaction. Fever, rashes, swelling, and hematologic abnormalities, particularly short-term or long-term injury to one or more organs, have been reported by over 0.4 percent of patients following the course of medicine. Here, a 54-year-old female patient was admitted to the hospital with complaints of fever, purpuric rashes over the body with itching mainly in the oral cavity and lips, and the extent to the upper back and lower limbs for three days. She had known complaints of Type 2 Diabetes, Systemic hypertension, Coronary artery disease with recent NSTEMI, Dyslipidaemia, Psychosis (20y), and Chronic kidney disease. She had been taking Allopurinol for the past three months for hyperuricemia. Allopurinol treatment stopped while topical Steroid treatment started along with supportive therapy. After ten days, the rashes improved significantly, allowing her to leave the hospital.

Sudden cardiac death is estimated to affect approximately three million people worldwide each year. Substrates and triggers often play a complex role in these deaths. Among the heart cells, disturbed potassium homeostasis is one such trigger. Hypokalemia and transient drops in potassium concentration are significant issues. Heart failure (HF) therapy is increasingly complicated by maintaining normal serum potassium (K+) homeostasis. As a result of the use of loop diuretics hypokalemia has become a severe and feared side effect of treatment. Hypokalemia in HF also indicates greater neurohormonal activity and progression of disease. Personalized drug use and monitoring of electrolytes are crucial for successful treatment. The lowest dose of diuretic necessary to maintain euvolemia should be prescribed to HF patients with symptoms (New York Heart Association Class III-IV). Aldosterone receptor antagonists, spironolactone can be used to treat mild hypokalemia. For more severe, K + supplement is recommended. Levels should be routinely monitored and kept between 4.0 and 5.5 mEq/l.

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Amlodipine is a dihydropyridine calcium channel blocker mainly indicated in the treatment of essential hypertension and angina pectoris. Overdose of calcium channel blocker, Amlodipine results in toxicity along with profound hypotension and shock. Here, a 20-year-old female patient was admitted to the MICU with complaints of severe breathing difficulty, and multiple episodes of vomiting one day earlier. After the chest x-ray, ECG, and blood investigations, she was diagnosed as having Amlodipine toxicity, pulmonary edema, circulatory shock, hypocalcemia, hypokalemia, systemic hypotension, and acute kidney injury. She was discharged from the hospital after the symptoms had recovered.