SHM Converge Scientific Abstract ePoster Gallery-Dress Syndrome: Recognizing a Rare Adverse Drug Reaction

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This case report describes a 54-year-old woman who developed Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome after starting carbamazepine for trigeminal neuralgia. Three weeks after treatment initiation, she presented with a diffuse pruritic maculopapular rash, hypotension, tachycardia, and cervical lymphadenopathy. Laboratory findings showed leukocytosis with marked eosinophilia, hyponatremia, acute kidney injury, transaminitis, and elevated lactate. Infectious evaluation was negative, supporting a drug-related hypersensitivity reaction.<br /><br />She was admitted to the ICU with shock and treated with norepinephrine and systemic corticosteroids for suspected carbamazepine-induced DRESS. Her renal and liver function improved with treatment, and she was discharged on day 4 with a six-week prednisone taper. At follow-up, her rash had completely resolved.<br /><br />The discussion highlights that DRESS is a rare but potentially life-threatening T-cell–mediated drug reaction, typically occurring 2–8 weeks after exposure to common triggers such as anticonvulsants, antibiotics, and allopurinol. It is characterized by fever, widespread rash, facial edema, lymphadenopathy, eosinophilia, atypical lymphocytosis, and internal organ involvement. Differentiating DRESS from other severe cutaneous adverse reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis can be difficult. Management relies on immediate discontinuation of the offending drug, and systemic corticosteroids are commonly used; more aggressive therapies may be needed in refractory or severe cases.<br /><br />The report emphasizes the importance of early recognition, as DRESS carries significant morbidity and mortality, most often due to severe liver involvement. Clinicians should maintain vigilance when prescribing carbamazepine and monitor closely for early signs of hypersensitivity.

Asset Subtitle

FNU Sahil

Meta Tag

Author List Ans Ahmad, FNU Sahil, Husban Halim, Michael Linz

Category Clinical Vignettes

Concept Drug Reaction with Eosinophilia and Systemic Symptoms

Concept Offending Medication Discontinuation

Concept Rash

Concept Eosinophilia

Concept Internal Organs

Distinguished Non-Finalist

Presenter Organization CMEF/NEOMED IM Program

Presenting Author FNU Sahil

Track Adult

Keywords

DRESS syndrome

carbamazepine

trigeminal neuralgia

eosinophilia

maculopapular rash

hypotension

acute kidney injury

transaminitis

systemic corticosteroids

drug hypersensitivity

Drug Reaction with Eosinophilia and Systemic Symptoms

Offending Medication Discontinuation

Rash

Eosinophilia

Internal Organs