Amoxicillin-induced DRESS syndrome without eosinophilia

Key clinical messageDespite the name, eosinophilia is not essential for diagnosing drug reaction with eosinophilia and systemic symptoms (DRESS syndrome).Early recognition and stopping the offending drug are vital to managing this condition, as it can otherwise lead to high mortality rates. Case presentationA 47-year-old African female with no prior medical history was prescribed amoxicillin 1.5 gram per day in three divided doses for acute upper respiratory tract infection.She responded well, but eighteen days later she reported fever, a skin rash on her limbs and trunk, widespread body itching, yellowish discoloration of the eyes, and abdominal pain marked on the left upper region.Physical examination was notable for fever, sclera jaundice, facial edema, diffuse erythema and scaling involving the trunk, limbs and the face (Figure 1A).The oral mucosa lining was intact.There was tenderness on left hypochondriac, and the liver