Abstract Background Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare, severe drug-induced hypersensitivity reaction characterized by skin eruption, eosinophilia, fever, lymphadenopathy, and internal organ involvement. It carries a mortality rate of 10-20%, primarily due to multisystem organ failure. While anticonvulsants and sulfonamides are common triggers, fluoroquinolones like ciprofloxacin are rarely implicated. Early recognition and intervention are essential, particularly in critically ill or elderly patients. Case Presentation A 78-year-old African American woman with hypertension, diabetes, and hyperlipidemia presented with a diffuse, pruritic, erythematous, morbilliform rashes involving the face, trunk, extremities, and skin folds, along with facial angioedema. Symptoms began one week after completing ciprofloxacin for a urinary tract infection. She denied any new medication, food or herbal intake. She developed high-grade fevers (39 °C), rash desquamation, tongue swelling, painful oral ulcers, and axillary and inguinal lymphadenopathy. Initially, sepsis was suspected; however, cultures were negative and the infectious workup was unremarkable. Laboratory testing revealed marked eosinophilia (32%) with initially preserved renal and hematologic function. Over the hospitalization, the patient’s condition worsened. She developed acute kidney injury, fluid overload, and respiratory failure requiring mechanical ventilation and vasopressor support. After transfer to the intensive care unit (ICU), she developed pancytopenia, coagulopathy, and persistent lactic acidosis (lactate 20 mmol/L). A RegiSCAR score of 6 confirmed definite DRESS syndrome, although skin biopsy was nonspecific. Autoimmune and vasculitis panels were negative. Dermatology recommended continued high-dose intravenous methylprednisolone, with consideration of IVIG or plasmapheresis if no improvement. Despite comprehensive ICU support including ventilation, vasopressors, dialysis, blood products, and immunosuppressive therapy, the patient suffered two cardiac arrests. She developed hypoxic encephalopathy and subsequently expired. Discussion This case highlights the potential for DRESS syndrome to cause fulminant, immune-mediated multiorgan failure, even when triggered by a rare agent like ciprofloxacin. Its resemblance to sepsis and overlap with other critical illnesses complicate timely diagnosis and treatment. Conclusion DRESS syndrome should be considered in patients with recent drug exposure presenting with rash, eosinophilia, and systemic symptoms. Prompt recognition, withdrawal of the offending agent, and early initiation of immunosuppressive therapy are vital to improving outcomes in critically ill patients. This abstract is funded by: None
Tan et al. (Fri,) studied this question.