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DRESS syndrome — SCE Acute Medicine MCQ

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HardAcute Rheumatological/Dermatological EmergenciesDRESS syndromeSCE Acute Medicine

A 52-year-old man has fever, facial oedema, diffuse morbilliform rash, eosinophils 2.4 × 10⁹/L, ALT 620 IU/L and creatinine 176 micromol/L six weeks after starting allopurinol. What is the best initial disease-directed plan?

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Correct answer: C — Stop allopurinol and use specialist systemic corticosteroid for severe organ involvement

Explanation lettering: C = shown as A · A = shown as B · B = shown as C · E = shown as D · D = shown as E

B is correct. The latency, facial oedema, eosinophilia and hepatic and renal involvement indicate allopurinol-associated DRESS. Stop allopurinol permanently, assess all organs and involve dermatology and relevant specialties. Significant hepatitis or nephritis commonly warrants systemic corticosteroid with a slow, response-guided taper because relapse can follow rapid reduction. Antihistamine alone is insufficient. Rechallenge and immediate febuxostat substitution are unsafe, adrenaline treats anaphylaxis rather than delayed multiorgan hypersensitivity, and antibiotics are used only for a demonstrated infection.

Reference: https://www.medicines.org.uk/emc/product/13159/smpc