title: A case of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome complicating airway management.
abstract: OBJECTIVE
  Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multi-system reaction defined by fever, rash, eosinophilia, and internal organ involvement. The condition typically occurs one to eight weeks following exposure to inciting medications. In severe cases, it can develop into multi-organ system failure and death. We present a case of DRESS syndrome with mucosal edema that led to extreme difficulties with airway management.
  
  
  METHODS
  A 65-yr-old male treated for an esophageal perforation with broad-spectrum antibiotics developed fever, eosinophilia, and extensive rash consistent with DRESS syndrome. This condition resulted in a rapid progression to multi-organ system dysfunction, severe hemodynamic instability, and the need for high-dose vasopressors and tracheal intubation. Extensive mucous membrane involvement led to significant complications with airway management and a nearly impossible tracheal intubation, features in the disease not previously described. With the airway secure, initiation of steroids resulted in regression of the disease within 24 hr, resolution of airway edema, and uneventful tracheal extubation a few days later.
  
  
  CONCLUSIONS
  We emphasize the need for early identification of DRESS syndrome as well as the possible airway implications associated with this increasingly recognized clinical entity.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Asheesh.Kumar@med.navy.mil
authors.forename: Asheesh
authors.initials: A
authors.lastname: Kumar
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Goldfarb
authors.forename: Edward A
authors.initials: EA
authors.lastname: Bittner
mesh_terms: D000368:Aged; D058109:Airway Management / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology*; D004802:Eosinophilia / Q000209:etiology*; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D013577:Syndrome
chemical_list: D000900:Anti-Bacterial Agents