Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare, severe adverse drug event that appears with a generalized rash, fevers, and dysfunction of 1 or more organ systems. We describe 2 patients (1 adult and 1 pediatric) seen in the emergency department with DRESS, and review the clinical presentations, potential complications, and management of DRESS. Although rare, it can be associated with significant morbidity, including liver failure and death, and should be considered in the differential diagnosis of patients with diffuse rash and systemic symptoms.
Highlights
We describe 2 patients (1 adult and 1 pediatric) seen in the emergency department with Drug rash with eosinophilia and systemic symptoms (DRESS), and review the clinical presentations, potential complications, and management of DRESS
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction that is distinct from other drug-related reactions
We present an adult and a pediatric emergency department (ED) patient with DRESS, and review the presentation, potential complications, and management of DRESS
Summary
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction that is distinct from other drug-related reactions. The patient’s skin symptoms and laboratory abnormalities started improving on the second day of hospitalization He was discharged home after 3 days with a 6-week oral prednisone taper. The child’s physical examination was remarkable for a fever of 104.58F, heart rate of 117 beats per minute, blood pressure of 104/50 mm Hg, respiratory rate of 20 breaths per minute, and oxygenation of 100% on room air She was awake and alert with no acute distress, but appeared fatigued and in mild discomfort. The patient’s laboratory results (Table) were significant for transaminitis, elevated prothrombin time and international normalized ratio, decreased white blood cells, and atypical lymphocytes on peripheral smear (no eosinophilia was noted). She was discharged home on no psychiatric medications, but with close monitoring from both her psychiatrist and pediatrician
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