Elevated Liver Transaminase Levels as the Principal Characteristic of Drug Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Case Report Principal Characteristics of DRESS Syndrome

Abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a detrimental reaction of drug presenting as fever, skin eruptions, and internal organs involvement. DRESS has an increased mortality rate, estimated at 3 to 10%, primarily because of organ failure and sepsis. A  female aged 24 years, attended the hospital complaining of pruritus and widespread red maculopapular rash covering her entire body, accompanied by fine yellowish scaling. The patient also exhibited jaundice, passed melena stools that later turned pale, and had dark tea-colored urine. Laboratory results revealed a high white blood cell count of 11.280. The patient's SGOT was 358 (N:<35), SGPT 524 (N:<41), total bilirubin 23.61 (N:0.1-1.2), indirect bilirubin 14.90, and direct bilirubin 8.71. Based on the J-Scar and Regis-Scar diagnostic criteria, this case was categorized as probable. Severe DRESS Syndrome symptoms pose a life-threatening risk due to their multi-organ involvement. Clinical manifestations encompass erythematous lesions, facial edema, high fever, lymphadenopathy, leukocytosis accompanied by eosinophilia. The more severe presentations involve visceral symptoms such as hepatitis, encephalitis, pneumonitis, hemophagocytic syndrome, and multi-organ failure. Therefore, effective treatment methods are very important for managing DRESS. To conclued, this case represents a probable diagnosis of DRESS Syndrome according to the J-Scar and Regis-Scar criteria. Organ involvement in this case primarily affected the liver, as revealed by elevated transaminase levels. If the patient makes a full recovery, a favorable prognosis is anticipated in terms of their overall quality of life.