A Rare and Complex Overlap of Toxic Epidermal Necrolysis (TEN) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Case Report and Review of the Literature

Toxic epidermal necrolysis (TEN) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) are both life-threatening hypersensitivity reactions characterized by widespread cutaneous involvement and multiorgan damage. While these syndromes are distinct, overlapping cases are exceptionally rare and represent a diagnostic and therapeutic challenge due to their shared and divergent pathophysiological features. In this case report, we describe a 21-year-old male patient who developed overlapping TEN and DRESS following treatment with phenytoin, risperidone, and levofloxacin. The patient presented with widespread epidermal detachment, facial edema, lymphadenopathy, eosinophilia, and liver dysfunction. Clinical management required a multidisciplinary approach including prompt withdrawal of the offending drug, initiation of systemic corticosteroids and supportive care. This case highlights the critical importance of early diagnosis and tailored management in preventing severe outcomes. A review of the current literature on TEN-DRESS overlap syndrome is also provided, discussing potential immunological mechanisms, diagnostic criteria, and therapeutic strategies.