Ayurvedic Medication-induced Drug Reaction with Eosinophilia and Systemic Symptoms–Toxic Epidermal Necrolysis Overlap Syndrome

REPORTrevealed total serum bilirubin of 5 mg/dL, for which liver-supportive medications were prescribed.Despite this, bilirubin rose to 20 mg/ dL, prompting him to seek Ayurvedic therapy for 2 weeks, leading to temporary symptom resolution and bilirubin reduction to 4 mg/dL.Two weeks later, he relapsed with fever, jaundice, and a diffuse cutaneous rash.On admission, he was febrile, icteric, and had a IntroductIon Overlap SyndromeSevere cutaneous adverse reactions (SCARs) are a spectrum of lifethreatening conditions, ranging from SGEP to Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN).These entities are typically distinguishable based on their distinct clinical, laboratory, and histopathological profiles.However, in some cases these syndromes may present with overlapping features.Such cases challenge the traditional diagnostic boundaries and complicate clinical decision-making. 1 To facilitate accurate classification of SCARs, the European Registry of Severe Cutaneous Adverse Reactions (Regis CAR) has developed validated scoring systems.These tools are helpful to categorize the SCAR cases. 2,3An overlap syndrome is defined when a patient fulfils the diagnostic criteria-either probable or definite-for at least two distinct SCAR entities.In this context, we report a case of DRESS and SJS, emphasizing the complexity and diagnostic challenges associated with such presentations. case descrIptIonA 25-year-old male policeman with no comorbidities or alcohol use presented with a 1-month history of fever and jaundice.Initial labs