Drug Rash With Eosinophilia and Systemic Symptoms (DRESS) Syndrome Probably Related to Cefpodoxime: A Case Report

Abstract

Cefpodoxime is a common antibiotic with a favorable side effect profile. Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome has been described with several cephalosporins but not cefpodoxime. We report the probable first case of cefpodoxime-induced DRESS syndrome in a 52-year-old female patient. In our case, the patient presented with symptoms of DRESS syndrome 16 days after initiation of cefpodoxime. This case highlights the necessity of consideration of an iatrogenic reason for presenting signs and symptoms at all times. Reinforcing the importance of taking a thorough drug history and considering drug reactions even if onset of symptoms are delayed.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Associated with <b><i>Mycoplasma pneumoniae</i></b> Infection

“…According to the DRESS validation score established by the REGISCAR group [7], our patient has probable DRESS (4-point score) upon her admission: fever, eosinophilia, atypical lymphocytes, extent >50%, rash suggesting DRESS, in the presence of positive serology for Mycoplasma and negative serologies and blood cultures [7]. The association between DRESS and cephalosporins, as in our case, has been given more attention in the last few years [8, 9]. The EM-like morphology in DRESS is associated with more severe liver involvement [10]; interestingly, our patient had entirely normal liver functions; oral erosions are more compatible with the mycoplasma infection EM variant, hinting for a possible EM-DRESS overlap syndrome.…”

Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome Induced by Primary Anti-tubercular Medication: A Case Report

“…Genetic variations in enzymes such as cytochrome P (CYP) 450 enzyme, N-acetyltransferase, and epoxide hydrolase, which play a crucial role in detoxifying intermediate drug metabolites, can result in the accumulation of these metabolites [ 9 , 10 ]. This accumulation can trigger immune responses by activating CD4 and CD8 T cells [ 9 , 10 , 11 ]. Despite numerous culprit drugs, the precise genetic predisposition for DRESS syndrome remains unidentified.…”

“…The clinical vignette presented symptoms including fever, a widespread rash characterized by macules and papules, raised levels of liver enzymes, an increased white blood cell count with elevated eosinophils, and the presence of enlarged lymph nodes together with an enlarged liver. The RegiSCAR criteria were created to distinguish DRESS from other skin-related adverse reactions, such as SJS or toxic epidermal necrolysis [ 11 ]. The patient exhibited a RegiSCAR score of 6, indicative of the suggested diagnosis.…”

Cephalosporin-Induced Atypical DRESS Syndrome; a Tale of Two Cases

“…Drugs usually effective for the DRESS syndrome are antimicrobials, anticonvulsants, antihypertensives, antivirals, and antidepressants (5). Cephalosporins (particularly cefpodoxime) are infrequently responsible for this type of serious adverse cutaneous drug reaction (6). The presentation generally begins with fever, followed by the appearance of a rash accompanied by mucositis (usually oropharyngeal) and lymph node enlargement.…”