DRESS Syndrome Triggered by Sulphasalazine: Clinicopathological Correlation and Immune-Modulatory Management

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially life-threatening adverse drug reaction. We report a case of a 42-year-old female with Rheumatoid Arthritis who developed DRESS syndrome six weeks after starting sulfasalazine. She presented with fever, facial and body rashes, mucositis, and anasarca. The RegiSCAR Score of 6 was suggestive of a definite case of DRESS Syndrome. Laboratory findings revealed eosinophilia, atypical lymphocytes, and transaminitis. Skin biopsy confirmed drug-induced hypersensitivity with interface dermatitis. Sulfasalazine and other immunosuppressants were discontinued, and the patient was managed with cyclosporine, antihistamines, topical and systemic steroids, albumin infusion, and a high-protein diet. The patient showed marked clinical improvement and was discharged on the seventh day. This case highlights the importance of early recognition and prompt treatment in sulfasalazine-induced DRESS syndrome.