Henriques Adriana, Guerra Mariana, Correia Isabel, Nunes Ana Luísa, Lima Jandira
Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT.
Internal Medicine, Hospital Pedro Hispano, Matosinhos, PRT.
Cureus. 2025 Jan 3;17(1):e76840. doi: 10.7759/cureus.76840. eCollection 2025 Jan.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by widespread skin rash, multi-system involvement, and often eosinophilia. While anticonvulsants, allopurinol, and antibiotics are the most implicated agents, non-steroidal anti-inflammatory drugs (NSAIDs) such as celecoxib can be triggers in rare cases. We report the case of a 63-year-old female presenting with a 10-day history of jaundice, nausea, and right upper quadrant pain following repeated use of celecoxib. Initially diagnosed with acute hepatitis of unknown origin, she subsequently developed fever, respiratory failure, pancytopenia, and a maculopapular rash by the 20th day of hospitalization. The clinical diagnosis of DRESS syndrome was confirmed through a skin biopsy. Systemic corticosteroid therapy (methylprednisolone 0.5 mg/kg/day) led to progressive resolution of symptoms, leading to hospital discharge on day 28. This report highlights the diagnostic challenges of DRESS syndrome, particularly in the absence of eosinophilia and with rare triggers such as celecoxib.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征是一种严重的药物诱导的超敏反应，其特征为广泛皮疹、多系统受累，且常伴有嗜酸性粒细胞增多。虽然抗惊厥药、别嘌醇和抗生素是最常涉及的药物，但塞来昔布等非甾体抗炎药（NSAIDs）在罕见情况下也可能引发该综合征。我们报告了一例63岁女性患者，在反复使用塞来昔布后出现黄疸、恶心和右上腹疼痛10天的病史。最初被诊断为不明原因的急性肝炎，随后在住院第20天时出现发热、呼吸衰竭、全血细胞减少和斑丘疹。通过皮肤活检确诊为DRESS综合征。全身用糖皮质激素治疗（甲泼尼龙0.5mg/kg/天）使症状逐渐缓解，患者于第28天出院。本报告强调了DRESS综合征的诊断挑战，尤其是在无嗜酸性粒细胞增多且由塞来昔布等罕见触发因素引起的情况下。
