Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug reaction characterized by skin rash, fever, lymph node enlargement, and single or multiple organ involvement. Prompt diagnosis and withdrawal of the offending drug reduce mortality.We report a case of DRESS syndrome along with a review of the literature. We identified the case as DRESS syndrome based on the skin rash, fever, eosinophilia, and liver and kidney involvement. According to the European Registry of Severe Cutaneous Adverse Reactions to Drugs and Collection of Biological Samples (RegiSCAR), our patient had a score of 6.Drug rash with eosinophilia and systemic symptoms syndrome is a severe form of drug reaction with the potential for significant morbidity and mortality. Human leukocyte antigens (HLA) screening may be performed to prevent disease in susceptible patients. Steroids in a tapering dose are helpful in the resolution of symptoms.

Organophosphate (OP) is a pesticide that has been used in agriculture and domestic pest control since the mid-1900s. Acute OP toxicity is caused by inhibiting the acetylcholinesterase (AChE) enzyme, resulting in a cholinergic surge. It is treated with atropine and pralidoxime. Our case is a patient with a past history of sleeve gastrectomy and intestinal bypass surgery presented after oral OP intake. He initially had small bowel enteritis, followed by lactic acidosis, acute renal injury, and distributive shock. The serum troponin had peaked 50-folds. The echocardiography showed myocardial depression and global hypokinesia with no significant wall motion abnormalities. In contrast to classic bradycardia with OP poisoning, our patient developed persistent sinus tachycardia on the second day. He had a concomitant alcohol withdrawal syndrome, which was managed with intravenous (IV) hydration and benzodiazepines. He had a dramatic improvement on the third day with near resolution of creatinine and lactic acid. The outpatient cardiac follow-up showed partial resolution of the left ventricular ejection fraction (EF) to 48%. In this literature, we discuss the complications and long-term effects of bariatric surgeries, particularly on gastric emptying and medication absorption. We also discuss OP mechanism of action, clinical presentation, therapeutic lines, and atypical presentations in the prior literatures.

The sodium-glucose co-transporter-2-inhibitors (SGLT2I) recently gained a unique role in managing the heart failure reduced ejection fraction. These inhibitors reduce cardiovascular (CV) risk factors, including plasma glucose, blood pressure, albuminuria, body weight, and renal events in the long term. The clinical trials proved their role in reducing hospitalization for HF, CV and all-cause mortality, atherosclerosis-related events, and CKD progression. Initiating this medication on decompensated heart failure or post-discharge reduces the risk of re-hospitalization. These co-transporter inhibitors reduced heart failure and kidney events regardless of baseline biomarker concentration or diabetes mellitus status. This article aims to the metabolic paradigm and cellular metabolism by exposing the available clinical trials of this novel therapy for heart failure, uncovering the possible mechanisms of action on the CV system, and describing the positive effect on prognostic markers as pro-BNP, as well as changing the plasma renin-aldosterone activity, cardiac troponin T (hs-cTnT), and insulin-like growth factor-binding protein 7 (IGFBP7).