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Drug Reaction With Eosinophilia and Systemic Symptoms (Dress) Syndrome and Myocarditis: A Case Report and Literature Review on Fatal Complications of Reactivated Viral Infections Publisher Pubmed



Tajerian A1 ; Pourvali A1 ; Movahedi M2 ; Mohammadi M1 ; Khansarinejad B3 ; Pourmatin M4 ; Ghandi Y1 ; Daneshmand MA5
Authors
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Authors Affiliations
  1. 1. Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
  2. 2. Division of Allergy and Clinical Immunology, Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Microbiology and Immunology, Arak University of Medical Sciences, Arak, Iran
  4. 4. National Forensic Medicine Organization, Arak, Iran
  5. 5. Daneshmand Pathology Laboratory, Arak, Iran

Source: Iranian Journal of Allergy, Asthma and Immunology Published:2024


Abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a complex and potentially fatal hypersensitivity condition. We present a unique case report and literature review focusing on DRESS syndrome-associated myocarditis resulting from reactivated viral infections in a 21-year-old female. 3 weeks after 5-day oral co-trimoxazole consumption due to acne, she developed symptoms consistent with DRESS syndrome, including a generalized maculopapular rash. Despite prednisolone treatment, the patient developed fatal fulminant myocarditis linked to HHV-6 and CMV reactivation. The patient's death highlights the importance of early recognition and careful management of DRESS syndrome, especially considering the potential viral reactivation that can lead to severe complications. Postmortem investigations revealed that viral reactivation caused myocarditis. Careful consideration must be given to corticosteroid usage in DRESS treatment, as inappropriate prescribing may promote viral reactivation and subsequent complications. While high-dose corticosteroids initiated within the first week effectively suppress HHV-6 reactivation. Conversely, low-dose or late-start high-dose corticosteroids prove ineffective in preventing HHV-6 viremia. Late- onset or low- dose corticosteroids may lead to fatal complications following the primary viral reactivation. Copyright © 2024 Tajerian et al. Published by Tehran University of Medical Sciences.