SHM Converge Scientific Abstract ePoster Gallery-Double Trouble: Dress vs Eosinophilic Granulomatosis in a Diagnostic Dilemma

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This case report describes a diagnostic challenge between DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) and EGPA (Eosinophilic Granulomatosis with Polyangiitis), two conditions that can share rash, eosinophilia, and systemic involvement but require very different treatments.<br /><br />A 53-year-old man presented with a purpuric rash on both legs and right foot numbness after recent exposure to Bactrim and tamsulosin. He had already visited the emergency department multiple times for similar episodes, each time being treated as a possible drug reaction with antibiotics and steroids. On admission, he was hypoxic and had marked leukocytosis with 49% eosinophils, mild liver enzyme elevation, and bilateral ground-glass opacities on chest X-ray. He was initially treated for presumed DRESS and community-acquired pneumonia, but infectious studies were negative.<br /><br />Because the rash and pulmonary findings did not improve with prednisone alone, further history revealed adult-onset asthma and recurrent sinus infections, raising concern for EGPA. ANCA and IgE were positive, and a skin biopsy later showed leukocytoclastic vasculitis with eosinophilic predominance, confirming EGPA. The patient improved rapidly after high-dose corticosteroids.<br /><br />The report emphasizes that EGPA may initially mimic a drug eruption, especially when symptoms begin soon after a new medication is started, creating anchoring bias. Clinicians should consider EGPA in patients with persistent rash, eosinophilia, pulmonary findings, neuropathy, recurrent asthma, or sinus disease, particularly when symptoms are refractory to standard DRESS therapy. Early recognition is important to prevent irreversible organ damage and improve outcomes.

Asset Subtitle

Ommara Jabbar

Meta Tag

Author List Anjum Dhamani, Dipaben Patel, Karina Gomez, Kishan Talagadadeevi, Ommara Jabbar, Pooja Amirneni

Category Clinical Vignettes

Concept Drug Reaction with Eosinophilia and Systemic Symptoms

Concept Eosinophilic Granulomatosis with Polyangiitis

Concept Eosinophilia

Concept Adult-Onset Asthma

Concept High-Dose Corticosteroid

Distinguished Non-Finalist

Presenter Organization Texas Health Resources

Presenting Author Ommara Jabbar

Track Adult

Keywords

DRESS

EGPA

eosinophilia

purpuric rash

drug reaction

leukocytoclastic vasculitis

adult-onset asthma

sinus infections

pulmonary infiltrates

corticosteroids

Drug Reaction with Eosinophilia and Systemic Symptoms

Eosinophilic Granulomatosis with Polyangiitis

Eosinophilia

Adult-Onset Asthma

High-Dose Corticosteroid