DRESS Syndrome Without Eosinophilia Presented with Extensive Skin Rash and Acute Respiratory Failure

Key Clinical MessageThis case demonstrated the complex pathophysiology of DRESS syndrome presenting with latent human herpesvirus infection reactivation due to exposure to sulfasalazine and/or hydroxychloroquine.Patients who do not initially fulfill the diagnostic criteria on admission may evolve and eventually fulfill the criteria.Steroid dose tapering is required to prevent flaring.