Acute interstitial nephritis and DRESS syndrome without eosinophilia associated with cefepime

Description

The drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is a potentially life-threatening drug-induced reaction characterised by a severe skin eruption, fever, haematological abnormalities (eosinophilia or atypical lymphocytes) and internal organ involvement (liver is the most common). These manifestations are thought to be a type IV hypersensitivity with a delayed onset of usually 2–6 weeks after the initiation of drug therapy.1 2 While the pathogenesis of this condition is not well understood, mechanisms such as detoxification defects leading to reactive metabolite formation and subsequent immunological reactions, slow acetylation and reactivation of Epstein-Barr virus and human herpesvirus 6 and 7 have been proposed.2 The most common drugs associated with DRESS syndrome are the aromatic anticonvulsants (phenytoin, phenobarbital, carbamazepine) and sulfonamides.3

A 62-year-old man with poorly controlled diabetes and subacute osteomyelitis presented to the hospital with fatigue, fever and anorexia. Prior...

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