[Diosmin-hesperidin-induced DRESS syndrome: immune reactivation by herpesvirus].

BACKGROUND

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction. The incidence is 1-1,000,000 with a mortality rate of 3.8-10%, and it is a disease associated with reactivation of the herpes simplex virus.

CASE REPORT: A 34-year-old woman with atopy and venous insufficiency presented with pruritic hives on her face and arms, which progressed to a morbilliform rash, facial edema, fever, lymphadenopathy, and scaling. A complete blood count showed no abnormalities: AST: 837 U/L, ALT: 11352 U/L. Due to the suspicion of DRESS syndrome, treatment with corticosteroids was initiated and a biopsy was obtained. Upon questioning, the patient reported having taken diosmin-hesperidin and undergone systemic sunscreen (Heliocare360°®) 21 days prior to the onset of the rash. Histopathological examination revealed atrophic epidermis, vacuolar degeneration, and inflammatory infiltrate. Systemic corticosteroids were administered for three weeks, with a satisfactory response. Two months later, the patient experienced reactivation of the dermatosis and hypertransaminasemia; the autoantibody panel and serology were positive for IgM for herpes simplex virus.

CONCLUSION

This case underscores the need to consider severe hypersensitivity reactions, even with commonly used and apparently low-risk drugs. The importance of a comprehensive approach, including identification of the suspected medication, exclusion of differential diagnoses, prolonged clinical follow-up, and surveillance for possible viral reactivation, is emphasized.