LADY IN RED: A FATAL CASE OF DRESS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, life-threatening drug-induced hypersensitivity reaction. The following case illustrates diagnostic complexities. CASE PRESENTATION: A 72 year-old female hypertension, DM2, newly diagnosed gout presented to our ED complaining of worsening abdominal rash diarrhea for one month after an extensive outpatient evaluation. She reports her began as erythematous patches on stomach week starting allopurinol gout, followed by nonbloody diarrhea. went urgent care where she was prescribed methylprednisolone dose pack, diphenhydramine needed, metronidazole possible colitis. Her worsened coalesced across abdomen. were discontinued, however developed intermittent fevers advised come ED. On arrival, afebrile, hemodynamically stable, but appeared confused diffusely tender CBC showed leukocytosis up 20k cells/uL (n: 5-12k) marked 22% which remained elevated throughout hospital stay. started IV fluids Piperacillin/Tazobactam. CT abdomen diverticulosis without acute inflammation. Neurology GI consulted who follow-up. Blood cultures sterile. Two weeks later returned the ER recurrent again now desquamating. had resolved, liver enzymes rose >3 times upper limit normal lipase. high glucocorticoid therapy admitted close monitoring DRESS. condition deteriorated despite therapy. into cardiopulmonary arrest day 3, intubated transferred ICU. hypotensive fluid resuscitation multiple vasopressors. expired two days later. DISCUSSION: DRESS characterized severe rash, fever, hypereosinophilia, end organ damage classically due medications including allopurinol. Symptoms can begin within exposure variable duration treatment. Our patient met criteria skin eruption, eosinophilia, damage. Treatment focuses prompt withdrawal offending drug, steroid administration. Research limited rarity disease, previous document incidence in .4% patients receiving allopurinol, series 38 found 5.3% exposed CONCLUSIONS: Careful prevent fatal cases REFERENCE #1: Choi HG, Byun J, et al. Allopurinol-induced syndrome mimicking biliary obstruction. Clin Mol Hepatol. 2014;20(1):71-75. #2: Thankachen Agarwal V. Challenges Diagnosis, Management, Allopurinol-Induced Syndrome: Report Literature Review. Am J Ther. 2015;22(3):e77-e83. doi:10.1097/MJT.0000000000000037 #3: Kardaun SH, Sidoroff A, Valeyrie-Allanore L, Variability clinical pattern cutaneous side-effects drugs symptoms: does really exist? Br Dermatol. 2007;156(3):609-611. doi:10.1111/j.1365-2133.2006.07704.x DISCLOSURES: No relevant relationships Amanda Dodson, source=Web Response Benjamin Drake, Stephen Fletcher, Emily Nix, Tusharkumar Pansuriya, Hytham Rashid, Mir Ali Sadat,