SHM Converge Scientific Abstract ePoster Gallery-Dress to Impress? Don't Tell My Achy-Breaky Heart! A Case of Hypersensitivity Myocarditis and Morbilliform Drug Rash Due to Sulfamethoxazole-Trimethoprim

Dress to Impress? Don't Tell My Achy-Breaky Heart! A Case of Hypersensitivity Myocarditis and Morbilliform Drug Rash Due to Sulfamethoxazole-Trimethoprim

Back to course

Pdf Summary

This case report describes a 77-year-old man who developed a severe hypersensitivity reaction after taking sulfamethoxazole-trimethoprim for a suspected urinary tract infection. He initially presented with a painful, pruritic morbilliform rash involving the torso, groin, and extremities, along with odynophagia. Because of concern for Stevens-Johnson syndrome, he was transferred to a tertiary center, where the rash was initially treated as a drug eruption with topical steroids and antihistamines.<br /><br />Over the next several hospital days, he developed persistent fevers, worsening rash, peripheral eosinophilia, elevated alkaline phosphatase, and rising cardiac biomarkers. Further evaluation showed new wall-motion abnormalities and reduced ejection fraction on transthoracic echocardiogram. Cardiac MRI confirmed myocarditis, consistent with hypersensitivity myocarditis as part of a DRESS-like drug reaction. Oral prednisone led to defervescence and improvement in the rash. He was discharged on a prednisone taper and started on heart failure therapy, including metoprolol and sacubitril-valsartan.<br /><br />The authors highlight that the timing of symptoms was atypical for classic DRESS because the patient had received steroids early, which likely obscured the clinical picture and delayed recognition of systemic involvement. This delay contributed to additional antibiotic exposure and a longer hospital stay.<br /><br />The report emphasizes that clinicians should consider DRESS or related systemic drug hypersensitivity even when presentation is early or incomplete, especially with known trigger medications like sulfamethoxazole-trimethoprim. Prompt evaluation for organ involvement, including myocarditis, is important because cardiac complications can significantly worsen prognosis.

Asset Subtitle

Ryan Fanning

Meta Tag

Author List Jennifer K. Readlynn, Ryan Fanning

Category Clinical Vignettes

Concept Drug Reaction with Eosinophilia and Systemic Symptoms

Concept RegiSCAR criteria

Concept Trimethoprim-sulfamethoxazole

Concept Type IV Hypersensitivity

Concept Myocarditis

Distinguished Non-Finalist

Presenter Organization University of Rochester School of Medicine and Dentistry

Presenting Author Ryan Fanning

Track Adult

Keywords

DRESS syndrome

sulfamethoxazole-trimethoprim

drug hypersensitivity

myocarditis

Stevens-Johnson syndrome

morbilliform rash

eosinophilia

cardiac MRI

heart failure

prednisone

Drug Reaction with Eosinophilia and Systemic Symptoms

RegiSCAR criteria

Trimethoprim-sulfamethoxazole

Type IV Hypersensitivity

Myocarditis