DRESS Syndrome — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementDRESS SyndromeORE Part 1

Three weeks after starting carbamazepine for trigeminal neuralgia, a patient develops fever, a widespread maculopapular eruption and oral ulceration. Blood tests show eosinophilia and abnormal liver function tests. Which diagnosis is most likely?

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Correct answer: C — Drug reaction with eosinophilia and systemic symptoms

The correct answer is C: drug reaction with eosinophilia and systemic symptoms (DRESS). NICE describes DRESS as a delayed reaction, usually 2–6 weeks after first drug exposure, with a widespread maculopapular eruption, fever, eosinophilia and liver dysfunction. Carbamazepine is a recognised cause, and its UK SmPC specifically describes DRESS as a delayed multi-organ hypersensitivity reaction with fever, rash, eosinophilia and abnormal liver function tests. Stevens-Johnson syndrome can cause fever and oral mucosal lesions, but is more characteristically associated with painful erosions, vesicles or blistering, epidermal detachment and purpuric/targetoid lesions; eosinophilia with hepatic involvement instead supports DRESS. Contact dermatitis, viral exanthem and erythema multiforme do not account for this characteristic drug latency plus eosinophilia and systemic hepatic involvement.

Reference: NICE. Drug allergy: diagnosis and management (CG183), table of clinical patterns of suspected drug allergy, updated 2024. https://www.nice.org.uk/guidance/cg183/resources/drug-allergy-diagnosis-and-management-35109811020229