Sudden worsening of DRESS syndrome on tapering steroid dose with dramatic improvement on N-acetylcysteine and steroid dose escalation

Abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a serious and life-threatening drug reaction characterized by fever, skin rash, peripheral eosinophilia, presence of atypical lymphocytes in peripheral blood smear, generalized lymphadenopathy and involvement of other body organs. The only agreed-upon therapy for DRESS in literature is withholding the culprit drug. There are no controlled trials on the use of steroids in this condition. Reports on the use of N-acetylcysteine in DRESS are very few. We report here a case of 36 year old female with severe DRESS that deteriorated rapidly upon tapering steroid therapy and dramatically improved on combination of pulse steroid therapy and N-acetylcysteine. This paper suggests that higher doses and gradual tapering of corticosteroid is a wise approach in treating patients with DRESS. It further emphasizes the possible beneficial role of N-acetylcysteine in this condition.