Two Successfully Treated Cases of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS Syndrome): a Review of Literature and Case Report

Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), also known as druginduced hypersensitivity syndrome (DIHS), is a rare, severe, potentially life-threatening disorder that might affect internal organs.DRESS differs from other drug eruptions by late onset and the possible persistence or worsening even after drug discontinuation [1].Clinical presentation of DRESS encompasses a wide spectrum of symptoms, including cutaneous eruptions such as a maculopapular rash, fever, lymphadenopathy, hematological abnormalities (e.g.eosinophilia and atypical lymphocytes), facial edema, and multi-organ involvement affecting the liver, kidneys, lungs, pancreas, heart, and other organs.Compared to other cutaneous adverse drug reactions, DRESS has a delayed onset, with initial symptoms typically appearing 2 to 8 weeks after treatment initiation, although this timeframe may vary depending on the specific drug administered.Having been reexposed to the drug, the patient develops symptoms more rapidly.The most common causes of DRESS are aromatic antiepileptic agents, allopurinol, AbstrActIntroduction: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is an uncommon yet potentially fatal hypersensitivity reaction triggered by specific medications.A typical clinical presentation consists of maculopapular skin lesions, eosinophilia, fever and internal organ involvement.Case report: This report highlights 2 cases of the DRESS syndrome caused by antiepileptic drug -lamotrigine and antibiotic -azithromycin.The first case involves an 18-year-old who developed widespread maculopapular rash, fever, lymphadenopathy, and elevated liver enzymes 3 weeks after initiating lamotrigine.The second case describes a 53-year-old female with severe rash covering 90% of her body, eosinophilia, and liver enzyme abnormalities shortly after azithromycin administration.Immediate discontinuation of the drug, combined with topical and systemic corticosteroids treatment led to the desired outcomes in both cases.Conclusions: These cases underscore the critical importance of early diagnosis and management of DRESS, particularly when prescribing commonly used medications such as antiepileptic drugs and antibiotics.