Gemcitabine-Induced Drug Rash With Eosinophilia and Systemic Symptoms (DRESS Syndrome): A Case Report

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare, severe, and potentially life-threatening hypersensitivity reaction characterized by fever, diffuse cutaneous eruption, hematologic abnormalities, most notably eosinophilia, and multiorgan involvement, predominantly hepatic. While classically associated with anticonvulsants, allopurinol, or sulfonamides, this syndrome may occasionally be triggered by antineoplastic agents. Gemcitabine, a nucleoside analogue with a generally favorable safety profile, is widely used in the treatment of various solid tumors. However, exceptional cases of severe immune-mediated cutaneous adverse drug reactions, including DRESS, have been described. We report the case of a 46-year-old man treated for nasopharyngeal carcinoma, who developed a febrile maculopapular rash with eosinophilia and hepatic cytolysis following gemcitabine-based chemotherapy. The diagnosis of DRESS was established according to RegiSCAR criteria, and clinical improvement was achieved after discontinuation of gemcitabine and corticosteroid therapy. This observation emphasizes the importance of early recognition of atypical hypersensitivity reactions during chemotherapy and the need for immediate drug withdrawal to prevent potentially severe complications.