Dress syndrome due to drugs and viral reactivation

Abstract

Introduction: DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a serious clinical picture of multisystem involvement that occurs in association with drugs and viral reactivation. It is potentially fatal, and it should be taken into account among the possible differential diagnoses when we are presented with a patient with febrile rash.Case report: A 41-year-old man with no medical history was receiving treatment with antibiotics trimethoprim-sulfamethoxazole and rifampin for septic arthritis. He developed a febrile rash during treatment, which was interpreted as DRESS syndrome. In complementary test, positive serology for Epstein Barr Virus was detected. Conclusions: In the presence of an adult patient with a febrile rash, there should be always the clinical suspicion of DRESS, as it is an usually infra-diagnosed syndrome. There are available different scores for diagnosis, severity, and treatment guidelines (RegiSCAR, DiHS). Besides, it is important to identify the presence of infection/reactivation with a herpesvirus because of the need for antiviral treatment in those cases.