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DRESS Syndrome — RACP Adult Medicine MCQ

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ModerateRheumatologyDRESS SyndromeRACP Adult Medicine

A 30-year-old man commenced on allopurinol 3 weeks ago develops high fever (39.5°C), a widespread morbilliform rash with facial oedema, generalised lymphadenopathy, and eosinophilia (2.5 × 10⁹/L). ALT is 450 U/L. Creatinine is rising. HHV-6 reactivation is detected. What is the most likely severe drug reaction?

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Correct answer: D — DRESS syndrome

Fever, morbilliform rash with facial oedema, lymphadenopathy, eosinophilia, hepatitis, renal involvement, and HHV-6 reactivation 2–8 weeks after drug initiation is DRESS syndrome. Allopurinol is a common cause (HLA-B*5801 screening recommended in at-risk populations before starting). Treatment is drug withdrawal plus systemic corticosteroids. Long-term autoimmune sequelae (thyroiditis, diabetes) occur in 10%.

Reference: RegiSCAR Criteria; eTG Dermatology 2024; AMH 2025