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DRESS Syndrome — SCE Dermatology MCQ

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ModerateDrug ReactionsDRESS SyndromeSCE Dermatology

A 40-year-old woman develops a widespread morbilliform drug eruption 10 days after starting Allopurinol. She has fever (38.5°C), facial oedema, lymphadenopathy, and blood tests show eosinophilia (2.1 × 10⁹/L) and raised ALT (180 U/L). What is the most likely diagnosis?

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Correct answer: B — Drug reaction with eosinophilia and systemic symptoms (DRESS)

DRESS syndrome is characterised by the triad of skin eruption (usually morbilliform), haematological abnormality (eosinophilia and/or atypical lymphocytes), and systemic organ involvement (hepatitis is most common). Onset is typically 2-8 weeks after drug initiation. Allopurinol is a well-known causative agent. RegiSCAR scoring criteria help confirm diagnosis. The presence of facial oedema is a distinctive feature. SJS/TEN shows epidermal detachment rather than morbilliform rash with organ involvement. Management includes drug withdrawal and systemic corticosteroids.

Reference: BAD 2019 Guidelines for management of drug eruptions