Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome without Eosinophilia: A Complication Secondary to Aceclofenac

A 27-year-old male presented with fever, oral ulcers, and generalized lymphadenopathy 5 days following consuming aceclofenac for toothache. He had hepatosplenomegaly in ultrasonography and transaminitis on investigations. After ruling out the other causes by appropriate tests, he was diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS) due to aceclofenac and was treated with systemic steroids with good outcomes. We describe a patient with DRESS due to aceclofenac in the absence of eosinophilia which is extremely unusual. Early recognition of DRESS is essential for proper management which can reduce mortality.