A NOVEL CASE OF DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) AFTER METOLAZONE USE

Abstract

<h3>Introduction</h3> Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially lethal delayed hypersensitivity reaction often triggered by high-risk drugs such as antiepileptics and antibiotics containing sulfonamides. To our knowledge, there are no reported cases of metolazone, a sulfonamide containing, thiazide diuretic as the causative agent of DRESS. Here we present a case of DRESS after metolazone usage. <h3>Case Description</h3> n.18-year-old male with a history of focal segmental glomerulosclerosis (FSGS) presented with rash, lower extremity edema and fatigue. On exam, the patient demonstrated an extensive hyperpigmented, macular, pruritic rash involving the abdomen, back, arms and legs. Initial labs demonstrated a leukocytosis of 16.5 × 10³/uL; 7.9 × 10³/uL eosinophils; and a worsening AKI with a creatinine of 3.88 mg/dL, which was 1.97 mg/dL 21-days prior. Four weeks before presentation, the patient had been initiated on metolazone for his underlying kidney disease. As a result, DRESS was suspected, and the patient was started on high dose prednisone with future doses of his metolazone held. Over the next several days, the patient's eosinophilia resolved and his rash and creatinine improved. <h3>Discussion</h3> Most cases of DRESS are caused by antibiotics and antiepileptic medications- thiazide diuretics are rarely implicated in the disease. Here we present a unique case of DRESS caused by metolazone. Clinicians should maintain a high index of suspicion for the disease when patient's present with multi-organ dysfunction, rash, and leukocytosis with eosinophilia in the setting of metolazone use.