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Septic Shock: An Unusual Presentation of Drug Reaction with Eosinophilia and Systemic Symptoms

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening, drug-induced hypersensitivity reaction that includes skin eruption, hematologic abnormalities, lymphadenopathy, and internal organ involvement. Clinical Description: An 11-year-old boy presented with high-grade intermittent fever and generalized rash for 7 days. He was started on phenytoin 1 month back. On presentation, the child was sick looking with 104°F fever, tachypnea, tachycardia, flushed with bounding pulses, and generalized edema suggestive of septic shock. Distinct diffuse erythematous, maculopapular rash with normal mucosae was noted all over the body with palmar and plantar erythema associated with hepatomegaly and ascites. Investigations showed eosinophilia. Management: The child was managed conservatively for septic shock, followed by withdrawing phenytoin and giving a pulse dose of methylprednisolone, followed by oral prednisolone. Conclusion: In children presenting with prolonged fever and rash with septic shock, DRESS syndrome should be considered differential diagnosis. A strong clinical suspicion and appropriate lab investigations is cornerstone of diagnosis.