A Complex Diagnostic Challenge of Dual Antibiotic-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome With Multiorgan Involvement

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a serious, immune-mediated hypersensitivity condition marked by cutaneous eruptions, fever, hematologic abnormalities, and involvement of multiple organ systems. We report a case of DRESS syndrome precipitated by IV vancomycin and minocycline, presenting with fever, diffuse morbilliform rash, marked eosinophilia, transaminitis, and acute kidney injury. The diagnostic process was challenging because of overlapping features between infectious and autoimmune etiologies, necessitating careful clinical correlation, medication review, and application of the Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) criteria. Early recognition enabled prompt discontinuation of the offending agents and initiation of systemic corticosteroids, resulting in gradual improvement in hepatic and renal function. This case underscores the need to maintain a heightened clinical suspicion for DRESS syndrome in patients treated with high-risk antibiotics. It reinforces the importance of prompt recognition and coordinated multidisciplinary care to reduce the risk of lasting organ injury.