Possible drug reaction with eosinophilia and systemic symptoms after spironolactone therapy for clinical hyperandrogenism: a case report.

OBJECTIVE

To present a case of possible drug reaction with eosinophilia and systemic symptoms (DRESS) after spironolactone and to review existing literature on serious cutaneous adverse reactions to spironolactone.

DESIGN

Case report and literature review.

SUBJECT: A 29-year-old woman with hyperandrogenism who developed a febrile, pruritic, generalized rash 1 week after initiating spironolactone.

EXPOSURE: Discontinuation of spironolactone.

MAIN OUTCOME MEASURES: Resolution of symptoms, RegiSCAR diagnostic assessment for DRESS.

RESULTS

Symptoms resolved after discontinuation and recurred upon two separate rechallenges. Although laboratory and histopathological data were not available to definitively confirm the diagnosis of DRESS, clinical features were suspicious for DRESS on the basis of RegiSCAR criteria. The patient met five diagnostic criteria, which would classify this as a "possible" case. Other reported cutaneous reactions to spironolactone include linear immunoglobulin A bullous dermatosis and erythema multiforme.

CONCLUSION

Clinicians should be aware of the rare but potentially serious risk of DRESS in patients treated with spironolactone. Prompt recognition, drug discontinuation, and supportive management are essential. Diagnostic confirmation with laboratory studies and skin biopsy should be pursued in suspected cases.