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DRESS syndrome following off-label use: case report A 50-year-old man developed DRESS-syndrome while receiving off-label treatment with azithromycin and hydroxychloroquine for COVID-19 infection. The man, who was initially admitted to the ICU due to pneumonia with acute respiratory distress syndrome, was diagnosed with COVID-19 infection. Nine days after admission, he developed generalised maculopapular rash on >70% of his body surface along with oedema of hands and face. He had been receiving treatment with azithromycin (for 18 days) and hydroxychloroquine (for 17 days) prior to the onset of skin eruptions [dosages and routes not stated]. His other ongoing medications at the time of admission included heparin, propofol, clonidine, norepinephrine, sufentanil and rocuronium. Other medications started after hospitalisation included pantoprazole (initiated 9 days prior), sevoflurane (initiated 8 days prior), cefuroxime (initiated 6 days prior) and flucloxacillin (initiated 4 days prior). Laboratory data showed elevated levels of CRP, absolute blood eosinophilia, atypical lymphocytes and D-dimer with abnormal renal function test and altered liver test. Skin biopsy analysis revealed oedema of the dermis associated with moderate perivascular infiltrate including lymphohistiocytic cells and eosinophils. Based on the examinations, a diagnosis of severe DRESS-syndrome was made. Consequently, all suspected drugs including azithromycin and hydroxychloroquine were discontinued. The man’s treatment was started with methylprednisolone. Gradual resolution of the symptoms was noted, and he was discharged from the ICU after 3 weeks. After complete resolution of the DRESS symptoms, tests for COVID-19 also showed negative results. Based on the chronology of development of symptoms, azithromycin and hydroxychloroquine were considered as the most probable suspects. Herman A, et al. Drug reaction with eosinophilia and systemic symptoms syndrome in a patient with COVID-19. Journal of the European Academy of Dermatology and 803498380 Venereology : no pagination, 31 Jul 2020. Available from: URL: http://doi.org/10.1111/jdv.16838

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Reactions 29 Aug 2020 No. 1819