Sanchez Emily J, Cheiky Elizabeth A
College of Osteopathic Medicine, Rocky Vista University, Englewood, CO, USA.
Am J Case Rep. 2025 Jun 13;26:e948217. doi: 10.12659/AJCR.948217.
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and severe hypersensitivity reaction triggered by medications, characterized by fever, rash, eosinophilia, and multi-organ involvement. While DRESS shares features with Stevens-Johnson syndrome (SJS) and fixed-drug eruption, distinguishing factors such as organ involvement, absence of mucosal lesions, and extended latency periods complicate its diagnosis. This case report aims to highlight an unusual presentation of DRESS to contribute to the growing understanding of its diagnostic and management challenges. CASE REPORT We present the case of a 25-year-old woman with DRESS attributed to trimethoprim-sulfamethoxazole (TMP-SMX) for acute pyelonephritis. Symptoms, including fever, diffuse maculopapular rash, facial edema, and lymphadenopathy, began within 6 days of drug exposure, deviating significantly from the typical 2- to 8-week latency period. Differential diagnoses, such as Stevens-Johnson syndrome and fixed-drug eruption, delayed the recognition of DRESS. A calculated RegiSCAR score of 5 indicated a probable case. Management included discontinuation of TMP-SMX, initiation of systemic corticosteroids, and supportive care. The patient experienced rapid symptom resolution without relapse, demonstrating a favorable outcome despite atypical features. CONCLUSIONS This case underscores the diagnostic complexities of DRESS, particularly in distinguishing it from other severe cutaneous drug reactions and managing atypical presentations with multiple drug exposures. It emphasizes the importance of early identification, timely cessation of the offending agent, and individualized treatment strategies. Further investigation into the role of concurrent antibiotic use in accelerating DRESS onset and exacerbating severity is warranted to enhance clinical understanding and improve patient outcomes.
背景 药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种由药物引发的罕见且严重的超敏反应，其特征为发热、皮疹、嗜酸性粒细胞增多及多器官受累。虽然DRESS与史蒂文斯 - 约翰逊综合征（SJS）和固定性药疹有共同特征，但诸如器官受累情况、无黏膜病变以及较长的潜伏期等鉴别因素使其诊断变得复杂。本病例报告旨在突出DRESS的一种不寻常表现，以促进对其诊断和管理挑战的不断认识。病例报告 我们报告一例25岁女性因急性肾盂肾炎服用甲氧苄啶 - 磺胺甲恶唑（TMP - SMX）引发DRESS的病例。症状包括发热、弥漫性斑丘疹、面部水肿和淋巴结病，在药物暴露后6天内出现，与典型的2至8周潜伏期有显著差异。诸如史蒂文斯 - 约翰逊综合征和固定性药疹等鉴别诊断延误了DRESS的识别。计算得出的RegiSCAR评分为5表明可能为该病例。治疗包括停用TMP - SMX、开始使用全身性皮质类固醇以及支持性护理。患者症状迅速缓解且未复发，尽管有非典型特征，但结果良好。结论 本病例强调了DRESS的诊断复杂性，尤其是在将其与其他严重皮肤药物反应区分开来以及处理有多种药物暴露的非典型表现方面。它强调了早期识别、及时停用致病药物以及个体化治疗策略的重要性。有必要进一步研究同时使用抗生素在加速DRESS发作和加重严重程度方面的作用，以增进临床认识并改善患者预后。
