Drug Reaction With Eosinophilia and Systemic Symptom (DRESS) Following Rifampicin Treatment: A Case Report

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic severe cutaneous adverse reaction (SCAR) characterized by a skin rash with systemic involvement (e.g., hematological, solid organ abnormalities). Various medications, most commonly anticonvulsants (carbamazepine, phenytoin), antibiotics (vancomycin, amoxicillin), and sulfa drugs (dapsone, sulfasalazine), have been implicated. We report a case of a 75-year-old man with pulmonary tuberculosis under anti-tubercular treatment (ATT Category 1 as per the national guidelines of Nepal) presenting with rash, fever, liver dysfunction, and eosinophilia, a combination of features suggestive of DRESS. According to the national tuberculosis (TB) survey of 2018-2019, over 117,000 people in Nepal were living with TB, including 69,000 newly diagnosed people. In third-world countries, such as Nepal, with a high TB prevalence, and the Southeast Asian region (with a huge percentage of the global burden of ‎TB‎ incidence), the risk of life-threatening adverse drug reactions during ATT is high. However, a good response is seen if it is recognized early and on stopping ATT and receiving a course of steroids and emollients.

How to recognize and manage challenging DRESS cases: Two case reports and a review of the literature

“…Although we did not perform thoracentesis to make a definitive diagnosis, we related pleural effusion to hypoalbuminemia rather than the syndrome itself. Also, authors who say that pleural effusion is a lung sign of DRESS do not say if a diagnostic thoracentesis was done 31 …”

“…Also, authors who say that pleural effusion is a lung sign of DRESS do not say if a diagnostic thoracentesis was done. 31 Acute interstitial nephritis occurs in 10%-30% of DRESS cases, and acute renal failure occurs in up to 8% of patients. 8,32 Renal involvement may be more common in allopurinol-induced DRESS cases.…”

COVID-19 Vaccine: A Common Suspect but Rare Culprit in Drug Rash With Eosinophilia and Systemic Symptoms (DRESS) Syndrome

“…Its etiology has been linked with lymphocyte activation, drug metabolic enzyme defects, eosinophilia, and human herpesvirus-6 reactivation [2]. The most common drugs to cause DRESS syndrome are antiseizure medications, antibiotics, and allopurinol [1]. The incidence of DRESS associated with antiepileptic drugs is reported at one in 1000 to one in 10,000 exposures with a mortality rate of about 10%, most commonly from fulminant hepatitis with hepatic necrosis [2][3][4].…”

“…Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but life-threatening condition that commonly presents with a diffuse rash, fever, lymphadenopathy, eosinophilia, and multiorgan involvement commonly involving the liver after drug exposure [ 1 ]. It is a delayed type IV hypersensitivity drug reaction.…”

“…It is a delayed type IV hypersensitivity drug reaction. Generally, symptoms of DRESS will begin about two to eight weeks after the initiation of the offending drug [ 1 ]. Its etiology has been linked with lymphocyte activation, drug metabolic enzyme defects, eosinophilia, and human herpesvirus-6 reactivation [ 2 ].…”