Acronym for Drug Rash with Eosinophilia and Systemic Symptoms.  Allergic reaction due to hypersensitivity caused by a medication : it appears to be a phenomenon of viral reactivation in a genetically predisposed patient. The most often involved viruses are of the  herpes type: EBV, HHV-6, HHV-7. 

The usual clinical manifestations are:

-         brisk onset, some weeks (3 weeks to 3 months) after the start of the treatment

-         skin rash accompanied by fever and generalized pruritus,  reaching the face and causing edema of the eyelids.

-         multiple adenopathies, hypo - or leukocytosis with eosinophilia

-         at least one organ is affected in 90% of cases: hepatitis (SGOT and SGPT up to 10 x higher than normal), nephritis, interstitial pneumonia.

Involved drugs:

-         anticonvulsant drugs with an aromatic ring: barbiturates, carbamazepine, phenytoin

-         sulfonamides, minocycline, calcium channel blockers, atenolol, allopurinol, captopril, phenylbutazone...

-         sometimes penicillins.

Treatment: corticosteroid therapy.

Anesthetic implications: 

poorly known; check the liver and kidney functions; avoid anesthetic agents whose chemical structure is similar to that of the offending drug. A case of extremely difficult intubation due to swelling of mucous membranes has been reported in an adult presenting a DRESS secondary to antibiotic therapy.

Keep the possibility of a DRESS in mind in presence of an itchy rash with swelling of the eyelids and in the context of recent drug intake.

References : 

-         Colomb S, Gonzalez D, Dissait F. 
Anesthésie d’un enfant atteint d’un DRESS syndrome pour réalisation d’une IRM. 
Ann Fr Anesth Réanim 2006 ; 25 : 213-214.

-        Kumar A, Goldfarb JW, Bittner EA. 
A case of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome complicating airway management. 
Can J Anesth 2012; 59: 295-8.

-        Rabenkogo A, Vigue MG, Jeziorski E. 
Le sndrome DRESS: une toxidermie à connaître. 
Arch Pédiatr 2015 ; 22 : 57-62.

Updated: August 2019