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Aggravation of DRESS syndrome and rebound effect: case report A 30-year-old woman experienced aggravation of DRESS syndrome during treatment with terbinafine for extensive tinea corporis. Subsequently, she exhibited rebound of the symptoms of DRESS syndrome following discontinuation of prednisolone for DRESS syndrome. The woman presented to the emergency department with high-grade fever and severely pruritic skin lesions that had spread to involve most of her body since past 3 days. She reported to have received multiple oral unspecified medications in the past 1 month. She had mild anaemia, leucocytosis and a combination of spongiosis and interface dermatitis. Based on the clinical findings and RegiSCAR criteria, she was diagnosed with DRESS syndrome. She started receiving oral prednisolone 40 mg/day along with supportive care, after which her symptoms began to subside. One week later, she started receiving oral terbinafine 250 mg/day along with sertaconazole lotion for extensive tinea corporis. However, the severity of pruritis and erythema increased secondary to terbinafine, indicating aggravation of DRESS syndrome [duration of treatment to reaction onset not stated]. The woman’s treatment with terbinafine was stopped. After 3 weeks, her erythema decreased and 80–90% lesions flattened. Subsequently, oral prednisolone was gradually tapered over 3 months and eventually stopped. However, 2 weeks following discontinuation of prednisolone, she presented with a recurrence of itchy papules and plaques over the limbs and abdomen (rebound effect). She denied to have taken any medications prior to relapse of cutaneous lesions. Blood findings revealed mild eosinophilia. Skin biopsy revealed eosinophil-rich infiltrate and numerous flame figures. Prednisolone was reinitiated and tapered over the following 6 weeks resulting in resolution of the lesions. No further recurrence was reported over last 1 year. Rajagopal SV, et al. Terbinafine induced DRESS syndrome mimicking eosinophilic cellulitis. Journal of the European Academy of Dermatology and Venereology : 11 Aug 803500912 2020. Available from: URL: http://doi.org/10.1111/jdv.16873

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Reactions 12 Sep 2020 No. 1821