Drug rash with eosinophilia and systemic symptoms syndrome

Last revised by Rohit Sharma on 21 Feb 2024

The drug rash with eosinophilia and systemic symptoms (DRESS) syndrome typically manifests as a skin rash, fever, lymph nodal enlargement with variable internal organ involvement, and represents a hypersensitivity reaction to medication.

Clinical presentation can be variable and symptoms may arise from 2 to 8 weeks after initiating the offending drug. Typical clinical features include skin rash, fever, lymph node enlargement, and internal organ involvement. In terms of internal organ involvement, it most commonly involves the liver, followed by the kidneys and lungs.

Serum eosinophils are often elevated, i.e. eosinophilia 5.

The pathophysiology of DRESS syndrome is not well known. Many drugs have been implicated as precipitants of this syndrome, including:

  • antiseizure medications

  • sulfonamides

  • dapsone

  • allopurinol

  • minocycline

  • gold salts

A CT chest is often non-specific but may show diffuse multifocal infiltrative opacification 5.

The prognosis can be variable but may carry a mortality of up to ~10% in patients with multiorgan involvement. Withdrawal of the causative drug and steroid therapy have traditionally been the mainstays of successful treatment. 

It was first described in 1996 by Bocquet et al 1.

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