DRESS Syndrome; Just a Rash or Much More?? Time to Rethink

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multiorgan drug induced idiosyncratic reaction. As the name suggests it is characterized by peripheral eosinophilia and systemic symptoms like fever, rash, lymphadenopathy, liver failure. Incidence is around 1:1000 to 1:10,000 drug exposures and has a high mortality if not diagnosed and treated timely. Diagnosis is difficult and challenging due to the diversity of symptoms this syndrome has, hence scoring systems like the RegiSCAR and Japanese criteria may be used. Mortality rate is around 10-20% and mostly due to liver failure. Most important step in treatment is withdrawal of the offending drug and supportive line of therapy with corticosteroids forming the mainstay of therapy. This paper reports two such cases which were a diagnostic dilemma and timely withdrawal of the offending drug and corticosteroids changed the course of the condition completely.