DRESS syndrome complicated by a severe acute hemolytic anemia

Abstract

A 25-year-old female patient, who had been receiving treatment for psychosis with carbamazepine, olanzapine, and haloperidol for the past 2 years, was admitted to the hospital after developing a widespread febrile rash. This occurred 15 days after taking fluoxetine and clomipramine. Upon examination, the patient presented with fever, tachycardia, and hypotension. Dermatological examination revealed a generalized erythema with fine scales, accompanied by eyelid swelling and bilateral cervical lymphadenopathy. Laboratory tests showed a normochromic normocytic anemia with a hemoglobin level of 3.5g/dL and lymphopenia with an elevation in LDH. The direct Coombs test was positive. A skin biopsy suggested a drug eruption. The diagnosis of DRESS syndrome was considered probable based on the diagnostic criteria of the RegiSCAR group. DRESS syndrome is a severe hypersensitivity reaction with various clinical manifestations that can be life-threatening. To date, no cases of DRESS syndrome associated with acute hemolytic anemia have been reported in the literature. However, it has been implicated in the development of autoimmune diseases in the medium and long term.