Sequential Drug-Induced DRESS Syndrome With Severe Rhabdomyolysis and Probable Myocarditis: A Case Report

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe hypersensitivity syndrome with multiorgan involvement. An 81-year-old man with cardiomyopathy and stage IV chronic kidney disease developed DRESS syndrome after sequential exposure to allopurinol and vancomycin. He presented with diffuse rash, eosinophilia, transaminitis, severe rhabdomyolysis (CK 19,228 U/L), and probable myocarditis (troponin 9,712 ng/L). Corticosteroids started late, and a repeat vancomycin dose was temporally associated with rapid multiorgan deterioration and death. This case illustrates a rare presentation of DRESS syndrome with concurrent rhabdomyolysis and myocarditis, emphasizing the lethality of delayed diagnosis and sequential exposure to high-risk agents.