Phenytoin-induced drug rash with eosinophilia and systemic symptoms syndrome in a child: A rare but serious adverse drug reaction

Abstract: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare, potentially fatal adverse drug reaction (ADR) most associated with anticonvulsants. Paediatric cases are uncommon and may present with atypical or early onset, posing diagnostic challenges. We report the case of a 10-year-old boy who developed high-grade fever, generalized maculopapular rash, lymphadenopathy, eosinophilia, and hepatic involvement shortly after initiation of phenytoin for epilepsy. Infectious causes were excluded. The patient fulfilled RegiSCAR criteria for definite DRESS (score = 7). Prompt withdrawal of phenytoin and initiation of systemic corticosteroids resulted in complete recovery. This case highlights the importance of early recognition of DRESS syndrome as a serious ADR, even when onset occurs earlier than the classical latency period.