Drug rash with eosinophilia and systemic symptoms syndrome due to anti-tb medication

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, idiosyncratic, multi-system reaction. This syndrome clinically characterized by fever, morbiliform eruption, pleural effusion, lymphadenopathy, cardiac & gastrointestinal disorders, renal and liver dysfunctions, hematological abnormalities. We report a case of DRESS syndrome from anti-TB therapy. A 58-year-old male with pulmonary TB presented with diffuse pruritic skin eruption, 6 weeks after starting Rifampin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE) therapy. Physical exam was significant for diffuse, exfoliative erythematous macules with target lesions involving the entire skin surface, without mucosal involvement. Laboratory data was significant for SGOT, SGPT and eosinophil. RIPE therapy was discontinued and patient was started on topical corticosteroids, oral acyclovir drug. After skin biopsy patient was put on systemic corticosteroid. Patient was discharged on day 16 with oral prednisolone and second line TB therapy. After 1 month the rashes disappeared completely and eosinophils returned to normal levels.