DRESS Syndrome in ICU : A Diagnostic Dilemma.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome can be severe and life-threatening especially in critical care setting if not diagnosed and treated in time. DRESS syndrome is an idiosyncratic drug reaction characterized by rash, fever, eosinophilia, lymphadenopathy and internal organ. Regis CAR (European Registry of Severe Cutaneous Adverse Reaction) scoring system is used for its diagnosis. Diagnosis of this syndrome can be challenging in critical care setting due to nonspecific clinical features, multiple confounding factors, use of polypharmacy, and its resemblance with sepsis and septic shock of varied etiologies. We report a case of 15-year-old boy who developed this syndrome after starting sulfasalazine, HCQ and NSAIDS all together, one month back for treatment of ankylosing spondylitis. This case report focuses on early suspicion and identification of this syndrome in critical care setting. This in turn should help in effective treatment of the illness by stopping offending drugs and timely initiation of steroid therapy. Further it may help in judicious use of antibiotics by holding irrational use of these drugs.