Severe Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Requiring Intensive Care Management in A Young Adult: A Case Report

Background: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare but potentially life-threatening severe cutaneous adverse reaction characterized by extensive skin eruption, hematologic abnormalities, and multiorgan involvement. Early recognition is crucial, as delayed diagnosis may result in significant morbidity and mortality.Case Presentation: We report the case of a 24-year-old previously healthy man admitted to the intensive care unit (ICU) with severe DRESS syndrome following carbamazepine exposure. Six weeks after initiation of treatment for newly diagnosed epilepsy, he developed high-grade fever, diffuse maculopapular rash, facial edema, cervical lymphadenopathy, and progressive respiratory distress. Laboratory investigations revealed marked eosinophilia (4.8 × 10⁹/L), atypical lymphocytosis, severe hepatitis (ALT 1,245 U/L; AST 987 U/L), acute kidney injury, and elevated inflammatory markers. Computed tomography demonstrated bilateral pulmonary infiltrates and generalized lymphadenopathy. The RegiSCAR score was 8, indicating definite DRESS syndrome.Management and Outcome: Carbamazepine was immediately discontinued. The patient required ICU admission for acute hypoxemic respiratory failure and received systemic corticosteroids (methylprednisolone 1 mg/kg/day), supportive care, and close monitoring of organ dysfunction. Progressive clinical and biological improvement was observed, allowing discharge from the ICU after seven days and hospital discharge after three weeks. No relapse occurred during six months of follow-up.Conclusion: This case highlights the importance of early recognition of DRESS syndrome and prompt withdrawal of the offending drug. Severe organ involvement may necessitate intensive care management, but favorable outcomes can be achieved with timely diagnosis and appropriate treatment.