title: Drug reaction with eosinophilia and systemic symptoms without skin rash.
abstract: Drug reaction with eosinophilia and systemic symptoms (DRESS) or drug hypersensitivity syndrome is considered as a severe cutaneous adverse drug reaction which is most commonly precipitated by aromatic anticonvulsants, lamotrigine, dapsone, allopurinol, minocycline, and salazopyrin. Its clinical manifestations are often variable. On rare occasions, it can present with only systemic involvement without any cutaneous features. A complete drug history is of paramount importance in making an early diagnosis. We report the case of a male patient who presented with fever, lymphadenopathy, hepatosplenomegaly, and hepatitis, 2 weeks after starting salazopyrin. The presence of atypical lymphocytes in the peripheral smear was indicative of a viral infection or a hematological dyscrasia. Bone marrow examination revealed a normocellular marrow with an increase in eosinophil precursors. Investigations for the common causes for fever and hepatitis were negative. The presence of eosinophilia, the temporal relationship of the symptoms with the initiation of treatment with salazopyrin, and the marked improvement on withdrawal of the drug along with the administration of systemic corticosteroids, were features consistent with the diagnosis of DRESS. With the incidence of this condition showing a rising trend, it is important for the clinician to be aware of its variable manifestations, as a delay in diagnosis and treatment can be fatal.
authors.affiliation: Department of Dermatology and Venereology, Government Medical College, Kozhikode, Kerala, India.
authors.forename: Sarita
authors.initials: S
authors.lastname: Sasidharanpillai
authors.affiliation: Department of Dermatology and Venereology, Government Medical College, Kozhikode, Kerala, India.
authors.forename: Manikoth P
authors.initials: MP
authors.lastname: Binitha
authors.affiliation: Department of General Medicine, Government Medical College, Kozhikode, Kerala, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Manikath
authors.affiliation: Department of Dermatology and Venereology, Government Medical College, Kozhikode, Kerala, India.
authors.forename: Anisha K
authors.initials: AK
authors.lastname: Janardhanan
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D016918:Arthritis, Reactive / Q000188:drug therapy; D003937:Diagnosis, Differential; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006801:Humans; D007719:Knee Joint; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D012460:Sulfasalazine; D011239:Prednisolone
keywords: Absence of skin lesions; drug reaction with eosinophilia and systemic symptoms; salazopyrin