A diagnostic dilemma: distinguishing a sulfasalazine induced DRESS hypersensitivity syndrome from a CD30+lymphoma in a young patient
Dublin Core
Title
A diagnostic dilemma: distinguishing a sulfasalazine induced DRESS hypersensitivity syndrome from a CD30+lymphoma in a young patient
Subject
Dress syndrome, Drug hypersensitivity, Sulfasalazine, RegiSCAR, CD30+lymphoma
Description
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction characterized
by cutaneous rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and life-threatening organ dysfunctions.
We describe the case of a 26 year old patient admitted to the Emergency Department for DRESS syndrome after
sulfasalazine treatment for rheumatoid arthritis in the right knee. Whole body computer tomography showed
multiple neck, chest, and abdominal lymphadenopathy with splenomegaly, massive ascites and severe hepatic
cytolysis. Serology results for Epstein-Barr Virus (EBV), influenza, measles, rubella, hepatitis A and B were negative.
The histologic analysis of skin, lymph node and bone marrow biopsies could not indicate a classical Hodgkin’s
Disease or iatrogenic immunodeficiency/EBV-associated lymphoproliferative disorder (LPD), Hodgkin type. The
relatively small caliber of the CD30+immunoreactive blastoid cells in the lymph nodes suggested reactive
immunoblasts rather than Hodgkin cells. The morphologic aspects of the lymph node biopsies with predominance
of T-cells were compatible with the diagnosis of a sulfasalazine-induced DRESS syndrome as the patient had a high
RegiSCAR score for DRESS. [DRESS Syndrome Foundation: Diagnosis and Treatment. (2023)] The patient’s complex
clinical course, marked by two hospital admissions, highlights the challenges in diagnosing and managing DRESS.
This case underscores the need for individualized care, close patient monitoring, and further research to better
understand DRESS’s underlying mechanisms and optimal therapeutic strategies.
Keywords Dress syndrome, Drug hypersensitivity, Sulfasalazine, RegiSCAR, CD30+lymphoma
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction characterized
by cutaneous rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and life-threatening organ dysfunctions.
We describe the case of a 26 year old patient admitted to the Emergency Department for DRESS syndrome after
sulfasalazine treatment for rheumatoid arthritis in the right knee. Whole body computer tomography showed
multiple neck, chest, and abdominal lymphadenopathy with splenomegaly, massive ascites and severe hepatic
cytolysis. Serology results for Epstein-Barr Virus (EBV), influenza, measles, rubella, hepatitis A and B were negative.
The histologic analysis of skin, lymph node and bone marrow biopsies could not indicate a classical Hodgkin’s
Disease or iatrogenic immunodeficiency/EBV-associated lymphoproliferative disorder (LPD), Hodgkin type. The
relatively small caliber of the CD30+immunoreactive blastoid cells in the lymph nodes suggested reactive
immunoblasts rather than Hodgkin cells. The morphologic aspects of the lymph node biopsies with predominance
of T-cells were compatible with the diagnosis of a sulfasalazine-induced DRESS syndrome as the patient had a high
RegiSCAR score for DRESS. [DRESS Syndrome Foundation: Diagnosis and Treatment. (2023)] The patient’s complex
clinical course, marked by two hospital admissions, highlights the challenges in diagnosing and managing DRESS.
This case underscores the need for individualized care, close patient monitoring, and further research to better
understand DRESS’s underlying mechanisms and optimal therapeutic strategies.
Keywords Dress syndrome, Drug hypersensitivity, Sulfasalazine, RegiSCAR, CD30+lymphoma
Creator
Natalija Aleksandrova1
, Jonas De Rop2,3, Frederic Camu1
, Ives Hubloue4
and Katleen Devue1*
, Jonas De Rop2,3, Frederic Camu1
, Ives Hubloue4
and Katleen Devue1*
Source
https://doi.org/10.1186/s12245-024-00665-7
Date
2024
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Natalija Aleksandrova1
, Jonas De Rop2,3, Frederic Camu1
, Ives Hubloue4
and Katleen Devue1*, “A diagnostic dilemma: distinguishing a sulfasalazine induced DRESS hypersensitivity syndrome from a CD30+lymphoma in a young patient,” Repository Horizon University Indonesia, accessed April 26, 2026, https://repository.horizon.ac.id/items/show/12385.