DRESS Syndrome: Drug Reaction with Eosinophilia and Systemic Symptoms/Drug-Induced Hypersensitivity Syndrome (DHS)

Abstract

DRESS is a potentially life-threatening drug reaction that typically presents with a diffuse morbilliform rash, fever, lymphadenopathy, eosinophilia, and some level of systemic organ involvement. While traditionally it was thought to be a reaction to antiepileptic drugs and sulfa-containing antibiotics, DRESS can occur after use of any medication. One of the defining characteristics of DRESS is the delayed reaction to the offending medication (2–6 weeks), differentiating it from other drug reactions which typically occur immediately after medication exposure. Systemic involvement can affect any organ system, but the hematologic, hepatic, renal, pulmonary, and cardiac abnormalities are the most commonly involved. DRESS has a 10% mortality rate mostly resulting from fulminant hepatic failure. Treatment includes admission to an ICU/burn unit for supportive care, discontinuation of the offending drug/medication, close monitoring for systemic organ involvement, and high-dose steroids with a prolonged taper (up to 3 months or more). There may be a role for antivirals but there is no current data supporting such.