A recurrent, fatal, DRESS syndrome, complicated by sepsis and severe systemic cytomegalovirus reactivation at relapse: a case report

  • Anna Castrovilli | annacastrovilli@me.com Interdisciplinary Department of Medicine, University Hospital Azienda Ospedaliera Consorziale Policlinico, Internal Medicine Unit Cesare Frugoni, School of Medicine, University of Bari, Italy.
  • Tommaso Mastrofilippo Interdisciplinary Department of Medicine, University Hospital Azienda Ospedaliera Consorziale Policlinico, Internal Medicine Unit Cesare Frugoni, School of Medicine, University of Bari, Italy.
  • Lucia Di Fino Interdisciplinary Department of Medicine, University Hospital Azienda Ospedaliera Consorziale Policlinico, Internal Medicine Unit Cesare Frugoni, School of Medicine, University of Bari, Italy.
  • Caterina Foti Department of Internal Medicine, Immunology and Infectious Diseases, Dermatology Clinic, School of Medicine, University of Bari, Italy.
  • Giuseppe Ingravallo Department of Hematology and Organ Transplantation, University Hospital Azienda Ospedaliera Consorziale Policlinico, School of Medicine, University of Bari, Italy.
  • Antonio Perrone Interdisciplinary Department of Medicine, University Hospital Azienda Ospedaliera Consorziale Policlinico, Internal Medicine Unit Cesare Frugoni, School of Medicine, University of Bari, Italy.
  • Carlo Sabbà Interdisciplinary Department of Medicine, University Hospital Azienda Ospedaliera Consorziale Policlinico, Internal Medicine Unit Cesare Frugoni, School of Medicine, University of Bari, Italy.
  • Francesco Saverio Vella Interdisciplinary Department of Medicine, University Hospital Azienda Ospedaliera Consorziale Policlinico, Internal Medicine Unit Cesare Frugoni, School of Medicine, University of Bari, Italy.

Abstract

We report a case of recurrent, fatal, DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome induced by allopurinol. A 57-year-old man was admitted to our clinic manifesting a severe skin rash and fever, after following a four-weeklong allopurinol therapy. On the basis of clinical, laboratory and instrumental features, the patient was diagnosed with DRESS syndrome, following RegiSCAR and Japanese group’s criteria. The clinical course of the disease was complicated by viral infection, methicillin-resistant Staphylococcus aureus endocarditis, bacterial pneumonia and severe recurrences. Despite allopurinol therapy was suspended and systemic steroids, targeted antibiotics, ganciclovir and immunoglobulins were administered, the clinical course had a fatal outcome. Herpes viruses have shown to have a crucial role in the pathogenesis of severe DRESS syndrome, suggesting that an early use of antiviral therapy, in addition to steroids, could improve the prognosis of DRESS syndrome.

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Published
2018-11-21
Section
Case Reports
Keywords:
DRESS syndrome, allopurinol, Herpes viruses, sepsis, antivirals.
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How to Cite
Castrovilli, A., Mastrofilippo, T., Di Fino, L., Foti, C., Ingravallo, G., Perrone, A., Sabbà, C., & Vella, F. S. (2018). A recurrent, fatal, DRESS syndrome, complicated by sepsis and severe systemic cytomegalovirus reactivation at relapse: a case report. Italian Journal of Medicine, 13(1), 48-53. https://doi.org/10.4081/itjm.2018.1091