Case Report: A Case of Transient DRESS Syndrome (Drug Rash with Eosinophilia and Systemic Symptoms)

We report a case of a 41-year-old female with a history of hypertension who presented with fever and a diffuse erythematous rash after taking trimethoprim-sulfamethoxazole (TMP-SMX) for an ear infection. Due to her symptoms, mild eosinophilia, and elevated liver function tests, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) was suspected. Although the patient’s rash had resolved by the time of initial evaluation, it recurred overnight, reinforcing suspicion for DRESS syndrome. TMP-SMX was discontinued, and acetylcysteine was administered due to the patient’s high-dose use of acetaminophen in the days prior to her hospital presentation. Infectious and autoimmune workups were negative. The patient was treated with a six-week prednisone taper and discharged with outpatient follow-up. DRESS is a potentially life-threatening drug reaction, most commonly triggered by sulfonamides, antiepileptics, and allopurinol. Early recognition and intervention are crucial, as management involves prompt drug discontinuation, corticosteroids, and prolonged monitoring.