Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Jan-Dec:9:2324709621997282.
doi: 10.1177/2324709621997282.

An Uncommon Presentation of DRESS Syndrome Secondary to Leflunomide Use: A Case Report

Suman Rao  1 , Akhila Sunkara  1 , Nimisha Srivastava  1 , Parth Sampat  1 , Christopher Ramos  1 , Emily Albert  1
Affiliations
Case Reports

An Uncommon Presentation of DRESS Syndrome Secondary to Leflunomide Use: A Case Report

Suman Rao et al. J Investig Med High Impact Case Rep. 2021 Jan-Dec.

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a constellation of symptoms that manifest as a result of certain medications. Several antipsychotics, antibiotics, and sulfa-containing drugs are known to be implicated in the etiology of DRESS syndrome. The clinical presentation of this disorder consists of a diffuse rash, lymphadenopathy, and systemic organ damage. Our patient presented with symptoms consistent with DRESS syndrome after being started on leflunomide, which is not commonly associated with DRESS. The diagnostic workup comprised of monitoring inflammatory markers on laboratory work, an excisional lymph node biopsy (to rule out malignancy), and a skin biopsy (to assess the etiology of the rash). Our patient received systemic steroids, dose-adjusted based on expert opinion. Further research is required to explore the association between leflunomide and DRESS and address guidelines for the management of DRESS.

Keywords: DRESS syndrome; leflunomide.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Diffuse inguinal lymphadenopathy seen on computed tomography scan of the abdomen/pelvis (marked by blue arrow).
Figure 2.
Figure 2.
Lymph node biopsy showing partial effacement of normal lymph node architecture with expansion of the paracortical areas (indicated by blue arrow) by mixed cellular proliferation (hematoxylin and eosin, 4× magnification).
Figure 3.
Figure 3.
Skin biopsy showing superficial perivascular inflammation (blue arrow) and mild spongiosis (red arrow). There is no interface change or overt vascular damage (hematoxylin and eosin, 4× magnification).
See this image and copyright information in PMC

References

    1. Bocquet H, Bagot M, Roujeau JC. Drug-induced pseudolymphoma and drug hypersensitivity syndrome (drug rash with eosinophilia and systemic symptoms: DRESS). Semin Cutan Med Surg. 1996;15:250-257. - PubMed
    1. Husain Z, Reddy BY, Schwartz RA. DRESS syndrome:part I. Clinical perspectives. J Am Acad Dermatol. 2013;68:693.e1-e14. - PubMed
    1. Kardaun SH, Sekula P, Valeyrie-Allanore L, et al.; RegiSCAR Study Group. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013;169:1071-1080. - PubMed
    1. Muller P, Dubreil P, Mahé A, et al.. Drug hypersensitivity syndrome in a West-Indian population. Eur J Dermatol. 2003;13: 478-481. - PubMed
    1. Kano Y, Shiohara T. The variable clinical picture of drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms in relation to the eliciting drug. Immunol Allergy Clin North Am. 2009;29:481-501. - PubMed

Publication types

LinkOut - more resources