DRESS Syndrome-An Unusual Presentation with Pancytopenia after Salazopyrin Treatment | Biomedgrid

Background: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare and potentially life-threatening adverse drug reaction. This syndrome is most frequently caused by various drugs such as allopurinol, Salazopyrin, antiepileptics (carbamazepine, lamotrigine, phenytoin, and phenobarbital), and antibiotics (sulfamethoxazole, dapsone, minocycline, and vancomycin). Treatment usually includes discontinuation of the offending drug and initiation of high-dose steroids with a prolonged taper. Objective: To describe an unusual case of DRESS syndrome with pancytopenia during the time of initial presentation, following a late appearance of rash and eosinophilia. Case Presentation: A 44-year-old woman was hospitalized in our internal medicine ward due to fever, cervical lymphadenopathy, pancytopenia and elevated liver enzymes one month after Salazopyrin therapy was initiated. A thorough investigation for malignant or viral etiology was performed and the lab results raised the suspicion of Hemophagocytic Lymphohistiocytosis (HLH). Subsequently, eosinophilia, atypical lymphocytes and a rash appeared 10 days after her initial presentation and DRESS syndrome was diagnosed. Conclusion: DRESS syndrome is a unique, potentially life threatening, entity that can present in the form of fever and pancytopenia with delayed appearance of rash, eosinophilia and atypical lymphocytes. The recent use of drugs described as related to DRESS should raise the preliminary suspicion. In order to avoid complications, a high index of suspicion is warranted.