Cefuroxime-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Case Report

Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe hypersensitivity reaction commonly triggered by anticonvulsants, allopurinol, and sulfonamides. Cephalosporin-induced DRESS is rare, with limited reports on cefuroxime as a causative agent. Case Description: A 60-year-old female presented with pruritus, jaundice, anorexia, right upper quadrant pain, and eosinophilia one month after taking cefuroxime. She subsequently developed acute kidney injury with a peak serum creatinine of 5.85 mg/dL, nephrotic-range proteinuria, and cholestatic hepatic dysfunction. Imaging revealed acalculous cholecystitis and cervical lymphadenopathy. Renal biopsy demonstrated plasma cell-rich tubulointerstitial nephritis (Figure 1a) and associated podocytopathy (Figure 1b). Given the multi-organ involvement and absence of alternative etiologies, a diagnosis of DRESS syndrome was established. High-dose prednisone was initiated, which helped improve eosinophilia and cholestatic jaundice; however, her renal function continued to deteriorate. She required inpatient and outpatient hemodialysis for 6 weeks before recovering renal function. At the 3-month follow-up visit, urinalysis was normal, and the serum creatinine level was 0.7 mg/dL. Discussion: This case highlights cefuroxime as a rare trigger of DRESS syndrome and underscores the importance of early recognition and intervention. Awareness of atypical presentations and complications is essential to improving patient outcomes.Figure 1a. Diffuse interstitial lymphocytic infiltrate with increased plasma cells and eosinophils on light microscopy. Figure 1b. Generalized effacement of podocytes on electron microscopy.