Atypical Presentation of Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome: When Gastrointestinal Symptoms Obscure the Diagnosis

The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous adverse reaction. Due to its unfamiliarity, non-specific diagnostic criteria, and delayed onset, this condition is frequently overlooked, which can sometimes result in life-threatening consequences. DRESS typically manifests as an extensive mucocutaneous rash with multi-organ involvement. This report aims to emphasize the varied presentation of the syndrome. Our patient was initially presented with acute onset vomiting, abdominal pain, fever for a couple of days with a minor skin rash. At first, she was treated for acute viral gastritis. However, on her second presentation within a week, she had a more extensive skin rash. Upon detailed history, it was found that this was linked to the initiation of sulfasalazine for ulcerative colitis. RegiSCAR (Registry of Severe Cutaneous Adverse Reactions) scoring suggested it as a definite case of DRESS. The primary manifestation of gastrointestinal symptoms led to a delayed diagnosis. Still, it is important to consider the possibility of drug hypersensitivity when there are skin changes and blood abnormalities present.