Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Secondary to Furosemide: Case Report and Review of Literature

Abstract

Patient: Male, 63Final Diagnosis: DRESS syndromeSymptoms: Diarrhea • fever • rash • shortness of breathMedication: FurosemideClinical Procedure: Skin biopsySpecialty: Internal Medicine • Family MedicineObjective:Rare diseaseBackground:DRESS is a rare, life threatening syndrome that occurs following exposure to certain medications, most commonly antibiotics and antiepileptics. While sulfonamide antibiotics are frequently implicated as causative agents for DRESS syndrome, furosemide, a nonantibiotic sulfonamide, has not been routinely reported as the causative agent despite its widespread use.Case Report:A 63 year old male who started furosemide for lower extremity edema 10 weeks prior presented with diarrhea, fever of 39.4°C, dry cough and maculopapular rash involving >50% of his body. He self-discontinued furosemide due to concern for dehydration. The diarrhea spontaneously resolved, but he developed hypoxia requiring hospitalization. CT scan demonstrated mediastinal lymphadenopathy and interstitial infiltrates. Laboratory evaluation revealed leukocytosis, eosinophilia and thrombocytopenia. He was treated empirically for atypical pneumonia, and after resuming furosemide for fluid excess, he developed AKI, worsening rash, fever and eosinophilia of 2,394 cell/µL. Extensive infectious and inflammatory work up was negative. Skin biopsy was consistent with a severe drug reaction. Latency from introduction and clinical worsening following re-exposure indicated furosemide was the likely inciter of DRESS. The RegiSCAR scoring system categorized this case as “definite” with a score of 8.Conclusions:We report a case of severe DRESS syndrome secondary to furosemide, only the second case report in medical literature implicating furosemide. Given its widespread use, the potentially life-threatening nature of DRESS syndrome and the commonly delayed time course in establishing the diagnosis, it is important to remember that, albeit rare, furosemide can be a cause of DRESS syndrome.

Ethosuximide‐induced drug reaction with eosinophilia and systemic symptoms with mediastinal lymphadenopathy

“…Lymphadenopathy is observed in up to 75% of DRESS syndrome cases, and its extent ranges from localized involvement to generalized lymphadenopathy . Mediastinal lymphadenopathy has been seldom discussed in the literature . Our patient was incidentally found to have bilateral mediastinal and hilar lymphadenopathy, which raised concern for lymphoma and led to a cervical lymph node biopsy.…”

Phenytoin Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Case Report

“…The physiopathology is not fully understood but seems multifactorial, particularly in cases with long clinical courses and flare-ups [1] [5]. The clinical features include a long latency period, skin involvement, hematological abnormalities, and impairment of internal organs [3] [4] [5] [10].…”

Fatal DRESS Syndrome Without Eosinophilia After Coronary Artery Bypass Grafting

“…Our case had fever, a morbilliform rash, bone marrow failure, hepatitis and pulmonary failure.The nonantibiotic sulfonamide furosemide causing dress was reported twice before. 9,10 Our patient used furosemide too, but we have no proof that if the culprit drug was that.…”