Atypical Manifestation of DRESS Syndrome

Abstract

The differential for liver transaminases over 1000 units/liter typically includes liver ischemia, acute viral hepatitis, acetaminophen toxicity, and autoimmune hepatitis. Prompt evaluation is imperative as these etiologies can lead to fulminant liver failure. We present a case of transaminases over 1000 units/liter from an atypical etiology. A 52-year-old male, previously treated with allopurinol for an acute gout flare, presented with persistent fevers. Given that he had taken a “high-risk medication” 2–6 weeks before presentation, subsequently presented with fever, rash, renal impairment, elevated liver enzymes in the thousands, and peripheral eosinophilia, DRESS syndrome secondary to allopurinol was diagnosed.

Uma Queimadura Solar Bizarra

“…The typical initial skin lesion is a morbilliform or maculopapular eruption. 5 Subsequently, it progresses to a diffuse, confluent and more infiltrated erythema and edema, but also purpuric lesions. [1][2][3][4][5] The liver is the most common organ affected in this syndrome.…”

“…5 Subsequently, it progresses to a diffuse, confluent and more infiltrated erythema and edema, but also purpuric lesions. [1][2][3][4][5] The liver is the most common organ affected in this syndrome. 5 Liver involvement is generally mild with rare progression to fulminant hepatic failure.…”

“…[1][2][3][4][5] The liver is the most common organ affected in this syndrome. 5 Liver involvement is generally mild with rare progression to fulminant hepatic failure. 5 Hematological findings are also commonly seen in DRESS syndrome, with eosinophilia being the most common manifestation.…”

“…5 Liver involvement is generally mild with rare progression to fulminant hepatic failure. 5 Hematological findings are also commonly seen in DRESS syndrome, with eosinophilia being the most common manifestation. 5 However, its absence does not exclude the diagnosis.…”

“…5 Hematological findings are also commonly seen in DRESS syndrome, with eosinophilia being the most common manifestation. 5 However, its absence does not exclude the diagnosis. 5 Diagnosis is often difficult.…”