Cefadroxil-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome After Double Mastectomy for Ductal Carcinoma In Situ: A Case Report

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a delayed hypersensitivity reaction to medications, characterized by a prodrome of malaise and fever, followed by skin and hematologic manifestations and end-organ damage. Typical causal agents of DRESS syndrome include allopurinol, aromatic anticonvulsants, and antibiotics. However, fewer than 3% of cases suggest cephalosporin-induced DRESS syndrome. A 43-year-old female developed a diffuse, erythematous, pruritic rash encompassing her whole body after starting prophylactic cefadroxil therapy before a double mastectomy for ductal carcinoma in situ. Her rash continued to worsen despite discontinuation of cefadroxil and developed a fever, myalgias, and generalized weakness. In the emergency department, she was noted to be febrile (103.5 °F) with elevated liver enzymes and eosinophilia, consistent with DRESS syndrome. She was admitted to medicine for further management with systemic steroids, intravenous fluids, and close observation. DRESS syndrome is a rare manifestation occurring after taking selected drugs. The signs and symptoms of DRESS syndrome may be indolent and persistent even after stopping the offending agent, as seen in this patient. Therefore, prompt treatment is necessary to prevent detrimental complications of the disease.