A 53-year-old male presented to the department of medicine with complaints of fever, abdominal pain for 2 weeks, and rashes all over the body for 10 days. The patient was diagnosed with Hansen’s disease 1 month back and was on a medication regimen of the following three drugs: dapsone (100mg/day), clofazimine (100mg/day) daily, and rifampicin (600mg) weekly. The patient’s vital examination showed a pulse rate of 100 beats/min and a fever of 100.2°F. Abdominal examination revealed ascites and mild hepatosplenomegaly. Respiratory examination revealed reduced air entry in the right lung. General examination revealed icterus, facial puffiness, and erythematous and pruritic rashes all over the body, including the face, neck, arms, chest, abdomen, and lower extremities Figure 1a–e, with intact mucus membrane.Figure 1: Shows erythematous and pruritic rashes on the face, neck, arms, chest, belly, and lower limbs. Peripheral smear eosinophils (e, red arrow).A palpable lymph node, firm in consistency and mobile with 2.2×2.0 cm in diameter, was found in the right axillary region. A laboratory hematological examination revealed hemoglobin 13.8g/dL, a white blood cell count of 14,500/μL, and a platelet count of 1.65 lakhs/μL. A peripheral differential count revealed eosinophilia of 22% (normal: 0–6%) Figures 1f and a high absolute eosinophil count of 3190/mm3 (normal: 30–350/mm3). Biochemical examination revealed a high total bilirubin of 5.3mg/dL with an indirect hyperbilirubinemia of 2.8mg/dL. The serological examination for typhoid, brucella, and scrub was negative. Chest radiography showed minimal pleural effusion on the right side. An ultrasound abdomen revealed pleural effusion, hepatomegaly, gallbladder wall edema, and ascites Figure 2.Figure 2: Ultrasound of the lower chest and abdomen shows pleural effusion (a), hepatomegaly (b), gall bladder wall edema (c), and ascites (d).Axillary lymph node biopsy histological examination revealed reactive lymph nodes. A diagnosis of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome secondary to anti-Mycobacterium leprae medication was made based on clinical, hematological, and radiological imaging. The patient was successfully treated with corticosteroids and modified to a new treatment regimen that included clofazimine, minocycline, and ofloxacin. DRESS syndrome is a rare but severe delayed hypersensitivity reaction and is commonly associated with medications like anticonvulsants, sulfonamides, antidepressants, anti-inflammatory agents, antivirals, angiotensin-converting enzyme (ACE) inhibitors, and beta-blockers.1 The term was first introduced by Bocquet et al. in 1996. The Bocquet criteria for diagnosing DRESS syndrome require the presence of skin eruption, eosinophilia >1.5×103/µL or atypical lymphocytes, and systemic organ involvement, including lymphadenopathy (>2cm), hepatitis (liver enzymes >2× upper limit), interstitial nephritis, pneumonitis, or carditis.2 This case highlights the importance of recognizing DRESS syndrome as a potential adverse effect of Hansen’s disease therapy, particularly dapsone. Prompt recognition and management, including drug withdrawal and supportive care, are crucial for favorable outcomes. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Momin et al. (Wed,) studied this question.