Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome in a Polymedicated Patient With Osteomyelitis: A Diagnostic Challenge.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but serious drug reaction that can be life-threatening. This report reviews a case of a male in his 30s with a history of extensive burn injuries, osteomyelitis, and bipolar disorder who was admitted to the hospital for left foot osteomyelitis after failing home intravenous (IV) piperacillin-tazobactam treatment. On hospital day 4, the patient began to develop a progressive macular rash. Laboratory results were significant for worsening transaminitis and elevated eosinophil levels, concerning for DRESS. Active inpatient medications included aripiprazole, lamotrigine, vancomycin, and meropenem. Lamotrigine and all antibiotics were discontinued in the setting of suspected DRESS. Treatment was initiated with IV methylprednisolone 175 mg daily, with a taper over eight to 12 weeks, and an infusion of N-acetylcysteine for liver injury, with eventual improvement of liver enzymes to baseline and resolution of eosinophilia. This case underscores the importance of prompt recognition of DRESS in patients with polypharmacy and complex infectious disease management.