Drug Reaction With Eosinophilia and Systemic Symptoms With Anti-tuberculosis Medication in a 44-year-old Filipino Woman With Recurrence on Reintroduction: A Case Report

Abstract Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) is a severe cutaneous eruption with associated systemic involvement, where host genetic factors, medication exposure, plus frequent viral reactivation, lead to activated T-cells and create a multiorgan inflammatory reaction. We report an unusual case of a 44-year-old Filipino, Female patient diagnosed with Multi-Drug rifampicin-resistant tuberculosis (MDR-TB) who presented with severe vomiting, fever, general malaise, flushing of the face, and pruritic erythematous morbilliform rashes over the face, abdomen, thorax, upper, and lower extremities about 4 weeks after starting a Standard Short Oral Regimen (SSOR) for MDR-TB. Clinical manifestation along with findings of eosinophilia, lymphadenopathy, transaminitis, hyperbilirubinemia, and ascites was initially suggestive of an autoimmune and liver damage, however, a high level of clinical suspicion and a definitive score of 6 from RegiSCAR for DRESS criteria eventually confirmed the diagnosis of DRESS syndrome. Treatment is focused on prompt recognition, withdrawal of offending agents, and supportive treatment. Oral corticosteroids showed gradual improvement with laboratory parameters decreasing toward acceptable range. However, the reintroduction of anti-TB treatment (ATT) proved to be a major challenge with the recurrence of DRESS syndrome occurring ultimately leading to treatment failure. Due to the complexity of DRESS syndrome's etiology and diagnosis, the utmost caution is needed with short-term and long-term management which includes the psychological and emotional aspects of patient care.