A Challenging Case of Trimethoprim-Sulfamethoxazole Associated Drug Reaction With Eosinophilia and Systemic Symptoms With Prominent Hepatic Involvement and an Atypical Rash

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening hypersensitivity reaction that manifests with a spectrum of cutaneous and systemic involvement. We present an unusual case of DRESS in a 26-year-old man with markedly elevated liver enzymes and hyperbilirubinemia but relatively limited skin activity. The patient had a recent diagnosis of human immunodeficiency virus infection and was treated with trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia and bilateral pneumothoraces. This case emphasizes the importance of maintaining a high clinical suspicion for DRESS in patients presenting with elevated liver enzymes and skin rash.