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DRESS syndrome, acute kidney injury and weight loss: case report A 74-year-old woman developed DRESS syndrome leading to acute kidney injury during treatment with carvedilol for idiopathic left ventricular failure. She also experienced weight loss and acute kidney injury secondary to furosemide [not all outcomes stated]. The woman presented with a 1-week history of progressive nausea, vomiting, diarrhoea and upper abdominal pain, without any rash or fever. One month before, she was diagnosed with idiopathic left ventricular failure, for which, she was initiated on furosemide, carvedilol, atorvastatin, cilazapril and aspirin [routes and dosage not stated]. She lost 4 kg due to furosemide titration. Examination showed mild abdominal tenderness in the right upper quadrant; however, there was no rash or lymphadenopathy. The white blood cell count and eosinophils were elevated. On day 5 of admission, eosinophils peaked at 15.8 x 109/L. She also developed acute kidney injury and liver function test (LFT) derangement, which peaked on day 4 of admission. Abdominal ultrasound was unremarkable. The woman’s treatment with cilazapril was discontinued 2 days before the admission. Subsequently, furosemide was discontinued on the admission day, and carvedilol was discontinued on the following day. Differential diagnosis for parasitic infection, eosinophilia, vasculitis, atopy and eosinophilic myocarditis were performed. Stool specimen was negative for cryptosporidium and giardia. Strongyloides serology and ANCA testing were negative. Cardiac MRI revealed severe left ventricular systolic impairment; however, no evidence of myocarditis or infiltrative disease was observed. Her pre-existing medications were colecalciferol and omeprazole. She had self-ceased aspirin after 1–2 weeks of therapy. Atorvastatin was continued throughout. Her symptoms improved following carvedilol cessation. Eosinophils gradually improved after 15 days. Before discharge, furosemide was reintroduced. Subsequently, cilazapril reintroduced after 1 week of discharge. Based on the RegiSCAR scoring system diagnosis was confirmed for carvedilol-induced DRESS syndrome. Also, treatment with furosemide and DRESS syndrome might have contributed in acute kidney injury. On a follow-up after 2 months, eosinophils and LFT were found normal. Jones L, et al. Not the usual suspects: DRESS secondary to carvedilol. New Zealand Medical Journal 133: 104-105, No. 1523, 9 Oct 2020. Available from: URL: https:// 803515787 www.nzma.org.nz/journal-articles/not-the-usual-suspects-dress-secondary-to-carvedilol

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Reactions 21 Nov 2020 No. 1831