SHM Converge Scientific Abstract ePoster Gallery-Lenalidomide-Induced Dress Syndrome: A Rare Chemotherapy Related Adverse Reaction

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A 73-year-old man with recurrent follicular lymphoma on lenalidomide, along with atrial fibrillation, coronary artery disease, and heart failure, was admitted for dyspnea, weight gain, and bilateral leg swelling. He was found to have a diffuse erythematous rash with superficial peeling and erythroderma, without mucosal involvement. Skin biopsy showed psoriasiform lichenoid dermatitis with eosinophils, apoptosis, and vacuolar changes at the dermal-epidermal junction, consistent with DRESS syndrome.<br /><br />Lenalidomide was discontinued, and treatment with oral prednisone 60 mg daily led to gradual improvement of the rash. He was discharged on a steroid taper and given Pneumocystis jirovecii pneumonia prophylaxis.<br /><br />The case highlights DRESS syndrome as a rare but potentially life-threatening hypersensitivity reaction that usually develops 3–6 weeks after drug exposure. It is characterized by rash, fever, eosinophilia, lymphadenopathy, and possible multi-organ involvement, especially affecting the liver, kidneys, and blood counts. Diagnosis is commonly based on RegiSCAR criteria and may be supported by skin biopsy.<br /><br />Although anticonvulsants, antibiotics, and NSAIDs are the most common causes, chemotherapeutic agents such as lenalidomide can also trigger DRESS. Early recognition, prompt withdrawal of the offending drug, and systemic corticosteroid therapy are essential for favorable outcomes.

Asset Subtitle

Narmada Lavu

Meta Tag

Author List Narmada Lavu, Vikas Kapoor

Category Clinical Vignettes

Concept Drug Reaction with Eosinophilia and Systemic Symptoms

Concept Drug Discontinuation

Concept Rash

Concept Eosinophilia

Concept Organ Involvement

Distinguished Non-Finalist

Presenter Organization Creighton University

Presenting Author Narmada Lavu

Track Adult

Keywords

DRESS syndrome

lenalidomide

follicular lymphoma

erythroderma

drug hypersensitivity

skin biopsy

prednisone

eosinophils

RegiSCAR criteria

systemic corticosteroids

Drug Reaction with Eosinophilia and Systemic Symptoms

Drug Discontinuation

Rash

Eosinophilia

Organ Involvement