Retinal hemorrhages and intermediate uveitis in a patient with drug reaction with eosinophilia and systemic symptoms syndrome: a case report.
OBJECTIVE
To report a case of drug reaction (or rash) with eosinophilia and systemic symptoms syndrome in association with intraretinal hemorrhages and intermediate uveitis.


METHODS
Single case report.


RESULTS
A 22-year-old Hispanic woman developed a facial rash and blurry vision after the use of oral trimethoprim-sulfamethoxazole for a urinary tract infection. Fundus examination revealed bilateral +2 vitritis and intraretinal hemorrhages in all four quadrants. An oral mucosal biopsy revealed V-shaped coagulative necrosis, intraepithelial and superficial acute and lymphoplasmacytic inflammation, consistent with drug hypersensitivity reaction.


CONCLUSIONS
Drug reaction (or rash) with eosinophilia and systemic symptoms syndrome can present as cutaneous rash, mucosal lesions, eosinophilia, intermediate uveitis, and intraretinal hemorrhages. In such cases, vitreoretinal manifestations may be considered as diagnostic criteria instead visceral involvement.
Departments of *Ophthalmology, and †Pathology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
Betsy
B
Colon
Juan M
JM
Horta
Stella
S
Casillas
Maria
M
Bertoli
Carmen
C
Gonzalez-Keelan
Armando L
AL
Oliver
D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects*; D004338:Drug Combinations; D063926:Drug Hypersensitivity Syndrome / Q000209:etiology*; D004802:Eosinophilia / Q000139:chemically induced; D005260:Female; D006801:Humans; D012166:Retinal Hemorrhage / Q000139:chemically induced*; D013419:Sulfamethizole / Q000009:adverse effects*; D014295:Trimethoprim / Q000009:adverse effects*; D015867:Uveitis, Intermediate / Q000139:chemically induced*; D055815:Young Adult; D000096926:Benzenesulfonamides
D000892:Anti-Infective Agents, Urinary; D004338:Drug Combinations; D013419:Sulfamethizole; D014295:Trimethoprim; C029078:trimethoprim sulfamethizole; D000096926:Benzenesulfonamides