Diffuse Alveolar Hemorrhage in the Setting of an Acute Exacerbation of Chronic Hypersensitivity Pneumonitis Due to Drug Rash With Eosinophilia and Systemic Symptoms: A Case Report

Drug rash with eosinophilia and systemic symptoms (DRESS) is a well-recognized phenomenon that is considered to be a hyperinflammatory reaction in response to the administration of a drug. It is typical to have systemic signs of inflammation, and the most commonly reported pulmonary manifestations include pneumonitis, interstitial lung disease, and acute respiratory distress syndrome. Here, we present a 62-year-old woman with a history of chronic hypersensitivity pneumonitis who presented in respiratory distress with a new progressive rash. Bronchoscopy demonstrated diffuse alveolar hemorrhage (DAH), and a clinical diagnosis of DRESS was made. The patient was diagnosed with respiratory failure from DAH in the setting of acute exacerbation of chronic hypersensitivity pneumonitis and DRESS. We review the available literature on the pathophysiology, diagnosis, and clinical presentation of DRESS and DAH. To our knowledge, there is no reported case associating DRESS with DAH.