Extensive pulmonary involvement with raltegravir-induced DRESS syndrome in a postpartum woman with HIV.

An 18-year-old postpartum woman with HIV, on lamivudine-zidovudine, lopinavir-ritonavir and raltegravir, presented with a 1-week history of rash and fevers. Initially admitted to obstetrics and gynaecology service for treatment of possible endometritis, she was transferred to the HIV medicine service for high fever, respiratory distress, hypotension and tachycardia. On admission, she was febrile (102°F) with findings of cervical and submandibular lymphadenopathy, diffuse morbilliform rash, generalised pruritus, facial oedema, and oedematous hands and feet. Consultations to various specialty services were initiated to rule out infectious, dermatological, rheumatological and drug-induced aetiologies. On the fourth day of hospitalisation, laboratory findings of significant eosinophilia and hepatitis (alanine aminotransferase 147 IU/L and aspartate aminotransferase 124 IU/L), in conjunction with the identification of the timing of medication use, led to a diagnosis of DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome secondary to raltegravir. After discontinuing raltegravir and starting prednisone, her DRESS symptoms completely resolved.