TOPIC: Allergy and Airway TYPE: Global Case Reports INTRODUCTION: Severe cutaneous adverse reactions (SCARs) are a group of disorders caused by a drug-induced hypersensitivity response. One important type of SCAR is Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) – a complex, multisystem, and possibly life-threatening drug response. Here we report a case of Lamictal associated DRESS which is rare and seldom reported. CASE PRESENTATION: A 44-year-old Caucasian female with past medical history significant for COPD on 3 liters home oxygen, bipolar disorder, recurrent mucocutaneous infections and seizures. She has been on Lamictal for treatment of seizures. Patient over last 2 years was admitted in hospital about 5 times with episodes of cough, wheezing and sob. she also had recurrent cutaneous abcesses. Her physician exam was consistent with middle aged female, with diffuse wheezing and skin lesions. Her historical chest x-ray has shown ongoing lll infiltrates, and so it was confirmed with cat scan showing diffuse GGO infiltrates more in left lower lobe. she was investigated with hypersensitivity pneumonitis panel, fungal serology, strep, legionella antigen which was negative. she had slightly lower IGG level. She kept on having these episodes inspire of optimal therapy . Only notable abnormal findings in her laboratory was elevated eosinophils count, with normal IGE level. Her initial count was 19% with sputum eosinophils. AS diagnosis of exclusion DRESS syndrome- associated with lamictal was diagnosed, which is quite rare and so therapy was discontinued and switched to alternative anti seizure therapy. Follow up in 2 months showing eosinophils count dropping to 3% with no recurrent symptoms. DISCUSSION: Several mechanisms are implicated as part of the pathogenesis underlying DRESS syndrome:. Most commonly DRESS is classified as a type IV delayed hypersensitivity reaction. Organ involvement in DRESS is due to eosinophil infiltration of the tissue causing damage. Liver is commonest organ affected followed by kidney and then lungs. Lung involvement can present with symptoms of dyspnea, cough, and/or pleuritic pain, pneumonia, interstitial pneumonitis, pulmonary nodules, or even acute respiratory distress syndrome (ARDS) in severe cases he European Registry for Severe Cutaneous Adverse Reactions (RegiSCAR) is an internationally recognized aid for which provides a clear definition and criteria for diagnosing DRESS syndrome. Though there is reasonable controversy exist about the diagnosis. The most important step in treatment of DRESS syndrome is prompt recognition and withdrawal of the offending drug. Systemic corticosteroids are generally considered the mainstay of therapy. immunosuppressive therapy should be used cautiously. CONCLUSIONS: DRESS is rare syndrome but should be included in the differential diagnosis for patients with peripheral eosinophilia and a medication history with a drug known to be a culprit for it. REFERENCE #1: Cho, Y.-T., C.-W. Yang, and C.-Y. Chu, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System. International journal of molecular sciences, 2017. 18(6): p. 1243. REFERENCE #2: Bocquet, H., M. Bagot, and J.C. Roujeau, Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Semin Cutan Med Surg, 1996. 15(4): p. 250-7. REFERENCE #3: Taweesedt, P.T., et al., Pulmonary Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review. Biomed Res Int, 2019. 2019: p. 7863815. DISCLOSURES: No relevant relationships by Abhijit Raval, source=Web Response no disclosure on file for Dhruv Raval