DRESS syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare adverse drug reaction. We report a rare case of DRESS syndrome secondary to antitubercular treatment (ATT). A 65-year-old male patient with pulmonary tuberculosis (TB) presented with fever, cough and breathlessness, flushing of the face, and itchy erythematous maculopapular rashes over the abdomen, thorax, upper and lower extremities for 3 days, about 4 weeks after starting fixed-dose combination (FDC) of antitubercular drugs-intensive phase therapy as recommended under the Revised National TB Control Programme (RNTCP). Investigations revealed eosinophilia, severe thrombocytopenia, cholestatic hepatitis, and acute kidney injury (AKI) with metabolic acidosis. FDC was withheld and the patient was managed as DRESS syndrome fulfilling diagnostic criteria. The patient showed gradual improvement with progressive return of laboratory parameters towards normal levels. DRESS syndrome following ATT is very rare with fewer case reports from India. Physicians prescribing ATT need to be aware of this severe hypersensitivity reaction to anti-TB drugs.