Metronidazole-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome With Parvovirus B19 Reactivation: A Pediatric Case

TL;DR

A 10-year-old child developed a severe drug reaction after metronidazole, linked to parvovirus B19 reactivation, and improved after stopping the drug.

Contribution

This case report highlights metronidazole as a potential trigger for DRESS syndrome with parvovirus B19 reactivation in a pediatric patient.

Findings

The patient showed DRESS symptoms after metronidazole treatment.

Parvovirus B19 reactivation was detected via IgM and IgG tests.

Discontinuing metronidazole led to improvement within seven days.

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe and rare syndrome that causes life-threatening organ dysfunctions. Here, we present the case of a 10-year-old child who developed a pruritic erythematous eruption, fever, facial edema, and lymphadenopathy seven days after receiving intravenous metronidazole (20 mg/kg/day), vancomycin (50 mg/kg/day), and cefotaxime (200 mg/kg/day). Laboratory tests showed eosinophilia and liver damage as well as positive parvovirus B19 IgM and IgG indicating viral reactivation. Vancomycin was initially discontinued and later reintroduced with no ill effects. The patient was managed with topical corticosteroid emollients and cetirizine and improved within seven days of metronidazole withdrawal. Treatment with cefotaxime was continued and showed no adverse effects.

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