Drug Reaction With Eosinophilia and Systemic Symptom (DRESS) Following Rifampicin Treatment: A Case Report

Drug reaction with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic severe cutaneous adverse reaction (SCAR) characterized by a skin rash with systemic involvement (e.g., hematological, solid organ abnormalities). Various medications, most commonly anticonvulsants (carbamazepine, phenytoin), antibiotics (vancomycin, amoxicillin), and sulfa drugs (dapsone, sulfasalazine), have been implicated. We report a case of a 75-year-old man with pulmonary tuberculosis under anti-tubercular treatment (ATT Category 1 as per the national guidelines of Nepal) presenting with rash, fever, liver dysfunction, and eosinophilia, a combination of features suggestive of DRESS. According to the national tuberculosis (TB) survey of 2018-2019, over 117,000 people in Nepal were living with TB, including 69,000 newly diagnosed people. In third-world countries, such as Nepal, with a high TB prevalence, and the Southeast Asian region (with a huge percentage of the global burden of ‎TB‎ incidence), the risk of life-threatening adverse drug reactions during ATT is high. However, a good response is seen if it is recognized early and on stopping ATT and receiving a course of steroids and emollients.