# Lady in Red: A Fatal Case of Drug Reaction With Eosinophilia and Systemic Symptoms

## TL;DR

A 72-year-old woman died from DRESS, a severe drug reaction, after being misdiagnosed with colitis and receiving delayed treatment.

## Contribution

This case emphasizes the need for early diagnosis and treatment of DRESS to prevent fatal outcomes.

## Key findings

- The patient was misdiagnosed with colitis and received multiple antibiotic courses before DRESS was identified.
- Delayed treatment with high-dose glucocorticoids failed to prevent deterioration and death.
- Early recognition of DRESS is critical to avoid fatal outcomes.

## Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, life-threatening drug-induced hypersensitivity reaction. Here, we present the case of a 72-year-old female patient who developed DRESS after starting allopurinol, a well-known causative agent. The patient initially presented to Urgent Care with rash and diarrhea where she was prescribed methylprednisolone dose pack, diphenhydramine as needed, and metronidazole for possible colitis. She had multiple outpatient clinic and emergency department visits for follow-up of fluctuating symptoms and a persistently elevated WBC count despite multiple courses of antibiotics for presumed colitis. After a prolonged clinical course, she was diagnosed with DRESS and admitted for high-dose glucocorticoids. Unfortunately, her condition deteriorated after transfer to the intensive care unit, and she passed away. This case highlights the importance of early consideration, diagnosis, and treatment of DRESS to avoid potentially fatal outcomes.