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DRESS syndrome — SCE Acute Medicine MCQ

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HardOtherDRESS syndromeSCE Acute Medicine

A 33-year-old woman develops fever, rash and facial swelling three weeks after starting allopurinol. She has lymphadenopathy, ALT 380 IU/L, eosinophils 2.1 × 10^9/L and creatinine 168 micromol/L. There is no mucosal sloughing. What is the most likely diagnosis?

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

The delayed onset after allopurinol, fever, facial oedema, eosinophilia, hepatitis and renal involvement are typical of DRESS. Stevens-Johnson syndrome is dominated by epidermal detachment and mucosal involvement, which are absent here. Management requires stopping the culprit drug and specialist dermatology/medical input because organ involvement can progress.

Reference: BAD Severe Cutaneous Adverse Reaction Guidance; BNF Allopurinol