ABSTRACT
Drug reaction with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic, potentially life-threatening, multisystem drug hypersensitivity disorder. The variable presentations that mimic many other diseases, prolonged latency period, and waves of the disease occurring over prolonged periods can make the diagnosis difficult. There is a complex interplay between the virus, the host immune response to the virus, and a drug-specific immune response, which produces the clinical picture in most cases. DRESS develops 2–6 weeks after initiation of the culprit drug on first exposure. Cutaneous features can range from maculopapular exanthem to erythroderma. The liver is the most common viscera to be involved and the primary cause of mortality from DRESS. Eosinophilia and raised liver enzymes are the most common laboratory features. The most important initial management is identifying the culprit drug and early withdrawal. The mainstay of active treatment is systemic corticosteroid therapy. Because relapse can occur when the dosage is reduced, a slow tapering of corticosteroids over a period of several weeks to months is often required.
