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DRESS Syndrome — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyDRESS SyndromeRACP Adult Medicine

A 55-year-old woman on carbamazepine for epilepsy develops a widespread maculopapular rash, fever, lymphadenopathy, and eosinophilia 4 weeks after starting the medication. Her ALT is 280 U/L. What is the most likely diagnosis?

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Correct answer: D — DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms)

DRESS syndrome typically occurs 2–8 weeks after drug initiation (longer latency than SJS/TEN) and is characterised by fever, rash, lymphadenopathy, eosinophilia, and organ involvement (hepatitis is most common). Carbamazepine, phenytoin, and allopurinol are classic causative drugs. The RegiSCAR scoring system aids diagnosis. Treatment involves cessation of the offending drug and systemic corticosteroids.

Reference: eTG – 2025 – Dermatology; AMH – 2025 – Adverse Drug Reactions