Drug reaction with eosinophilia and systemic symptoms syndrome secondary to acetazolamide associated with markedly elevated procalcitonin

• Published in: BMJ case reports Vol. 14; no. 1; p. e236966
• Main Authors: Ali, Syed Basharat, Schweikert, Sacha, Brusch, Anna
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 18.01.2021; BMJ Publishing Group
• Subjects: Abdomen; Acetazolamide - adverse effects; Aged, 80 and over; Antibiotics; Biomarkers - blood; Biopsy; Blood diseases; Carbonic Anhydrase Inhibitors - adverse effects; Case Report; Case reports; Cataracts; Chemotherapy; Coronary vessels; Creatinine; Delirium; Drug Hypersensitivity Syndrome - blood; Drug Hypersensitivity Syndrome - diagnosis; Drug Hypersensitivity Syndrome - etiology; Humans; Hypotension; Intensive care; Male; Neutrophils; Oliguria; Procalcitonin - blood; Purpura; Sepsis; Skin; ophthalmology; immunology; adult intensive care; unwanted effects / adverse reactions
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-236966

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an important cause of multi-organ dysfunction and can mimic other disorders including sepsis. We describe a patient presenting with septic shock and accompanying high procalcitonin. Although initially treated empirically with antibiotics, the emergence of eosinophilia during the admission lead to a revised diagnosis of DRESS syndrome, presumed secondary to acetazolamide. This case highlights the importance of regular clinical assessment and re-evaluation is key in identifying emerging features such as eosinophilia, rash and organ dysfunction, which can secure the diagnosis. Furthermore, the case also highlights that acetazolamide may be a rare cause of DRESS syndrome.