https://doi.org/10.4081/itjm.2018.1091

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

Vol. 13 No. 1 (2019)
Submitted: 21 September 2018
Accepted: 25 October 2018
Published: 21 November 2018
DRESS syndrome, allopurinol, Herpes viruses, sepsis, antivirals.
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Authors

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.

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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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

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