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Case Reports
. 2024 May 7;16(5):e59804.
doi: 10.7759/cureus.59804. eCollection 2024 May.

Atypical Presentation of Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) in a Patient on Pembrolizumab: A Case Report

Hillary Tran  1 , Geetika Bhatt  2
Affiliations
Case Reports

Atypical Presentation of Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) in a Patient on Pembrolizumab: A Case Report

Hillary Tran et al. Cureus. .

Abstract

Pembrolizumab is an immune checkpoint inhibitor that has been associated with numerous immune-mediated adverse effects. Several of these cutaneous side effects may include bullous pemphigoid, Stevens-Johnson syndrome, and drug reaction with eosinophilia and systemic symptoms (DRESS). Other case reports have reported DRESS as a rare side effect of immune checkpoint inhibitors but due to its variable presentation and similarities with other cutaneous diseases, it has proven to be a diagnostic challenge. In addition, no effective methods have been developed to monitor for such adverse skin reactions in patients on immunotherapy. Here, we report a diagnostic challenging case of pembrolizumab-induced blistering lesions that were initially treated as suspected Herpes zoster and/or bullous pemphigoid but further pathology was consistent with DRESS.

Keywords: cancer immunotherapy; drug reaction with eosinophilia and systemic symptoms (dress); immunotherapy side effects; pembrolizumab cutaneous side effect; pembrolizumab side effect.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Erythematous and blistering rashes on the upper extremities
(A) Demonstrates progressive blisters on the left arm, (B) Shows another view of the blisters on the left hand
Figure 2
Figure 2. Histopathology of the patient’s punch biopsy showing a superficial perivascular inflammatory infiltrate composed of lymphocytes and eosinophils (examples shown by black arrows)
Hematoxylin and eosin (H&E) 5x
Figure 3
Figure 3. Histopathology of the patient’s punch biopsy showing vacuolar interface dermatitis, with sparsely mixed dermal infiltrate with eosinophils consistent with DRESS
Hematoxylin and eosin (H&E) 20x DRESS: drug reaction with eosinophilia and systemic symptoms
See this image and copyright information in PMC

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