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Introduction <p>Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare, potentially life-threatening adverse drug reaction characterized by cutaneous eruptions, hematological abnormalities, and multi-organ involvement. Due to its uncommon occurrence and overlapping presentation with other conditions, it is often under-reported. Among antiepileptics, phenytoin remains a well-recognized trigger. Early recognition, prompt withdrawal of the offending drug and appropriate management are crucial to reduce associated morbidity and mortality.</p> Case Presentation <p>We report the case of a 19-year-old female who presented with low-grade fever, seizures, headache, and abdominal pain, and was started on antiepileptic therapy including fosphenytoin. After 18 days of treatment, she developed high-grade fever, diffuse pruritic erythematous rash, hypotension, and marked peripheral eosinophilia, raising suspicion of phenytoin-induced DRESS. Laboratory evaluation showed marked eosinophilia, deranged liver enzymes, and systemic involvement. Phenytoin was promptly discontinued and replaced with sodium valproate and levetiracetam. The patient was managed with systemic corticosteroids, antihistamines, and supportive care, leading to significant improvement with resolution of fever, rash, and systemic symptoms within nine days.</p> Conclusions <p>This case highlights the importance of high clinical suspicion, timely diagnosis, early withdrawal of the phenytoin and prompt initiation of corticosteroid-based therapy in managing phenytoin-induced DRESS syndrome.</p>

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A Case Report and Literature Review on Phenytoin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: Challenges and Clinical Management

  • 期刊论文

  • 发表日期：

    2026年8月1日

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  • Kavya Parekh,
  • Vishwa Patel,
  • Mehul R. Chorawala,
  • Bhavesh Shah,
  • Aneri Patel

摘要

Introduction

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare, potentially life-threatening adverse drug reaction characterized by cutaneous eruptions, hematological abnormalities, and multi-organ involvement. Due to its uncommon occurrence and overlapping presentation with other conditions, it is often under-reported. Among antiepileptics, phenytoin remains a well-recognized trigger. Early recognition, prompt withdrawal of the offending drug and appropriate management are crucial to reduce associated morbidity and mortality.

Case Presentation

We report the case of a 19-year-old female who presented with low-grade fever, seizures, headache, and abdominal pain, and was started on antiepileptic therapy including fosphenytoin. After 18 days of treatment, she developed high-grade fever, diffuse pruritic erythematous rash, hypotension, and marked peripheral eosinophilia, raising suspicion of phenytoin-induced DRESS. Laboratory evaluation showed marked eosinophilia, deranged liver enzymes, and systemic involvement. Phenytoin was promptly discontinued and replaced with sodium valproate and levetiracetam. The patient was managed with systemic corticosteroids, antihistamines, and supportive care, leading to significant improvement with resolution of fever, rash, and systemic symptoms within nine days.

Conclusions

This case highlights the importance of high clinical suspicion, timely diagnosis, early withdrawal of the phenytoin and prompt initiation of corticosteroid-based therapy in managing phenytoin-induced DRESS syndrome.