A rare case of rifampicin-induced drug reaction with eosinophilia and systemic symptoms syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an idiosyncratic adverse drug reaction that can be lethal in up to 20% cases. The commonest culprit drug includes phenytoin, allopurinol, phenobarbital, sulfasalazine and lamotrigine. DRESS syndrome due to antitubercular medicines is rarely reported. In India despite the widespread use of antitubercular medicines, only few cases of DRESS syndrome have been reported. Here we report an interesting case of a 23 year old girl who presented to us with complaints of high grade fever, cough, GI discomfort, numbness, severe pruritus and burning skin sensation. She was receiving antitubercular medicines for tubercular pleural effusion for the last three weeks. She was hospitalised for a suspected adverse drug reaction which was diagnosed as DRESS syndrome on the basis of RegiSCAR criteria. On re-challenge testing the culprit drug was found to be rifampicin. In this case the severity of skin involvement was much higher as compared to organ involvement.