Empagliflozin-related DRESS syndrome

A 61-year-old male with coronary artery disease, multiple percutaneous transluminal coronary angioplasty with stenting (PTCA + S recent 4 months back) and heart failure with reduced ejection fraction (with left ventricular ejection fraction of 39%) presented with complaints of itching and redness all over the body for 3–4 days and fever for 1 day. He was started on tablet Empagliflozin 10 mg/d a fortnight ago, which was the only change in his medications. His laboratory workup revealed an elevated total leukocyte count (11 200/mm³) with eosinophilia (19%) and an absolute eosinophil count of 2100/mm³, along-with raised C-reactive protein levels (87.98 mg/dL) and serum IgE (585.83 kU/L). His serum creatinine was raised (1.39 mg/dL), along with raised aspartate aminotransferase of 108 IU/L and alanine aminotransferase of 102 IU/L levels. He was diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome as per RegiSCAR DRESS validation score of seven and tablet empagliflozin was stopped. Drug reaction with eosinophilia and systemic symptoms syndrome is a distinct, severe, idiosyncratic reaction to a drug characterized by a prolonged latency period. It is followed by a variety of clinical manifestations, usually fever, rash, lymphadenopathy, eosinophilia, and a wide range of mild-to-severe systemic presentations. His condition improved with injectable steroid and supportive treatment over next 3 weeks.