Allopurinol associated drug reaction with eosinophilia and systemic symptoms (DRESS) in the setting of overlapping cutaneous adverse reactions of toxic epidermal necrolysis (TEN): A case report

Summary: Abstract Body: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) are severe cutaneous adverse reactions that pose significant diagnostic and therapeutic challenges. This case report describes a 73-year-old Indo-Guyanese male patient who developed a complex presentation of DRESS with features of TEN following the administration of Allopurinol for gout. The patient’s symptoms included a generalized, painful, pruritic maculopapular rash, fever, and mucosal involvement, which evolved despite initial treatment with corticosteroids and antihistamines. A broad differential for infection with fever and related skin involvement was kept at the forefront, closely monitoring the need for burn unit transfer in the setting of SJS/TEN. Patient initially necessitated in-patient admission to the medicine unit with the impression of DRESS syndrome. Despite aggressive management, the patient’s condition progressed, with extensive skin sloughing and mucosal involvement leading to a decision for transfer to a burn unit. The patient’s prognosis remains guarded, given the severity of the reaction and the extent of skin involvement (>30% body surface area). The overlap of DRESS and TEN in this patient underscores the importance of early recognition and comprehensive management of drug-induced hypersensitivity reactions. The case highlights the diagnostic challenges and the need for a multidisciplinary approach in managing such patients, including dermatology, infectious disease, and internal medicine consultations. The therapeutic interventions, including the use of intravenous immunoglobulin (IVIg) and corticosteroids, are discussed in the context of current literature to provide insights into effective management for similar cases. Saba Iqbal¹, Ydens Valeus^{2, 4}, Daniel Miller², Anushka Tomar³ 1. New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States. 2. NYC Health + Hospitals Queens Hospital Center, Jamaica, NY, United States. 3. Creedmoor Psychiatric Center, New York, NY, United States. 4. The City College of New York CUNY School of Medicine, New York, NY, United States. Clinical Research: Interventional Research