Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a life-threatening drug induced hypersensitivity syndrome that can present with a rash, facial edema, lymphadenopathy, visceral organ involvement, and eosinophilia. 1 We present a patient with DRESS following chikungunya infection, a possibly novel trigger.

A 57-year-old woman with a history of hypertension presented with facial swelling. She had traveled to Jamaica twenty-two days prior to this hospital visit and developed malaise, watery diarrhea and arthralgias during her trip. She initially presented to her primary care physician and was started on sulfasalazine. Two days later she developed a diffuse, erythematous, papular rash. She was admitted to the hospital, treated with antibiotics, and had improvement in the rash before discharge. However, she was admitted again seven days later with recurring fevers, facial swelling, intense pruritus, and worsening morbilliform rash. She was also found to have acute renal failure and transaminitis. While she did not have eosinophilia, her symptoms and course were concerning for DRESS, and she had atypical lymphocytes. She was started on intravenous steroids with improvement in symptoms and organ function and was discharged on a steroid taper. Given her diarrhea and arthralgias while in Jamaica, she was tested for tropical infections and results were positive for acute chikungunya infection.

This is a unique case of DRESS confounded by an early rash due to viral illness. Patient had a RegiSCAR DRESS score of 5, which suggested a diagnosis of DRESS, likely secondary to sulfasalazine. 2 It is theorized that viral illnesses can act as triggers for DRESS. Literature review revealed a previous report of chikungunya serving as a trigger for DRESS. 3 It is important to be cognizant of this possible correlation between DRESS syndrome and chikungunya, as early management can improve outcomes.

Accepted to 9th Annual BUMC Medical Education Research Forum 2023

Citations

1. Isaacs M, Cardones AR, Rahnama-Moghadam S. DRESS syndrome: clinical myths and pearls. Cutis. 2018;102(5):322-326.

2. Hama N, Abe R, Gibson A, Phillips EJ. Drug-Induced Hypersensitivity Syndrome (DIHS)/Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): Clinical Features and Pathogenesis. J Allergy Clin Immunol Pract. 2022;10(5):1155-1167.e5. doi:10.1016/j.jaip.2022.02.004

3. Sil A, Bhattacharjee MS, Chandra A, Pramanik JD. Sulfasalazine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) with concomitant acute chikungunya virus infection: possible role of new viral trigger. BMJ Case Rep. 2021;14(10):e244063. doi:10.1136/bcr-2021-244063