Telaprevir-Induced DRESS Syndrome Associated With Salmonella typhi

We present a case of a 48-year-old woman with HCV-related cirrhosis who presented with severe generalized plaque-like pruritic rash over a period of 2 weeks. The rash began during the 8th week of treatment with TVR-based triple therapy. Although TVR discontinuation was strongly recommended, the patient insisted on completing the 12-week regimen. During the 13th week, hospitalization was required due to aggravated pruritic skin rash (Figure 1), diarrhea, severe anemia (hemoglobin 6.7 g/dL), leukopenia (WBC 2,000/mm3/mL), eosinophilia (11%), and fever. Punch biopsy of the skin revealed superficial perivascular dermatitis (Figure 2). The patient was diagnosed with TVR-induced drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, and the diagnosis was supported as “probable” with the Naranjo score (7 points) and as “definite” with the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR; 6 points) criteria. Fevers persisted for 8 days, and blood cultures grew Salmonella typhi. The rash was treated with topical steroids, moisturizer, ciprofloxacin, and oral H1 and H2 receptor blockers. Systemic steroids were not used due to concern that this could precipitate severe systemic infection. The patient was discharged on day 28 of admission with resolution of rash and symptoms.