Does sensitization by SARS-CoV-2 immune complexes trigger DRESS syndrome?

Abstract

The diagnosis of coronavirus disease (COVID-19) has been a great challenge since the infection affects not only the respiratory system, but also different organs, given the intense inflammatory and autoimmune reaction triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein we present a case of a 36-year-old male patient, with some comorbidities and previous use of carbamazepine, who developed a severe condition triggered by COVID-19, including extensive exfoliative erythroderma and severe impairment of liver function, which lasted approximately 80 days.

Keywords: COVID-19; Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome; Exanthema; SARS-CoV-2.

Fig. 1

In the initial phase of the condition, erythroderma and digestive manifestations predominated, with abdominal distention, hepatomegaly, and diarrhea.

Fig. 2

Facial edema and enlargement of the nasal wings, lips, and tongue were present both in the erythematous phase and in the desquamative phase.

Fig. 3

Exfoliation reached the entire skin, including scalp, palms of the hands and soles of the feet, and was associated with sparse pustules and hyperpigmentation, especially in skin fold regions.