# Antibiotic-Associated Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) in a Young Male: A Case Report of Recurrence Without Organ Involvement

## TL;DR

A young man experienced a rare drug reaction (DRESS) twice after antibiotic use, highlighting the importance of early diagnosis and monitoring.

## Contribution

This case report demonstrates antibiotic-associated DRESS recurrence without organ involvement, emphasizing diagnostic challenges and long-term monitoring.

## Key findings

- DRESS occurred twice in a young male after ceftriaxone and H. pylori therapy antibiotics.
- No renal, hepatic, or cardiac involvement was observed in either episode.
- Positive autoantibodies suggest a risk of autoimmune sequelae requiring long-term follow-up.

## Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but severe idiosyncratic hypersensitivity reaction, most commonly associated with antiepileptics and allopurinol. Although antibiotics are increasingly recognized as triggers, they remain underreported. The syndrome is characterized by fever, rash, eosinophilia, and variable organ involvement, with mortality.

We report the case of a 26-year-old previously healthy male who presented with acute fever, diffuse morbilliform rash, facial edema, and eosinophilia following ceftriaxone exposure. His symptoms improved with corticosteroids and drug withdrawal, but he experienced a relapse shortly after starting Helicobacter pylori triple therapy. The second episode resolved with discontinuation of antibiotics and supportive care. Importantly, there was no renal, hepatic, or cardiac involvement in either episode, and the diagnosis of DRESS was confirmed with a RegiSCAR score of 3.

This case highlights the variable presentation of DRESS, the diagnostic challenge posed by its overlap with other severe cutaneous adverse reactions, and the potential for relapse following re-exposure to structurally unrelated antibiotics. While the absence of systemic organ dysfunction contributed to a favorable outcome, the presence of positive autoantibodies underscores the importance of long-term follow-up due to the risk of autoimmune sequelae. Antibiotic-associated DRESS should be considered in patients presenting with rash, fever, and eosinophilia. Early drug withdrawal, structured diagnostic scoring, and long-term monitoring are essential to reduce morbidity and detect late complications.