DRESS syndrome with the use of dapagliflozin: A case report and review of literature

Abstract

Background

The global prevalence of diabetes has quadrupled between 1980 and 2014, paralleled by a rise in mortality due to end-organ damage. Since their introduction in 2013, SGLT2 inhibitors (SGLT2i) have become a central component of diabetes management, supported by landmark cardiovascular outcome trials and randomized controlled studies that demonstrated significant cardiovascular and renal benefits. Although generally well tolerated, SGLT2i use has been associated with dermatologic adverse effects, ranging from mild rashes to severe conditions like Fournier’s gangrene. However, drug reaction with eosinophilia and systemic symptoms (DRESS) has not been previously reported in association with this drug class. DRESS, though rare, is a serious hypersensitivity reaction linked to several commonly prescribed medications.

Case Presentation

We report a 52-year-old man with type 2 diabetes who developed DRESS syndrome one month after initiating dapagliflozin. He presented with a morbilliform rash affecting >50 % of body surface area, mucosal involvement, fever, acute kidney injury, and elevated liver enzymes. Skin biopsy confirmed the diagnosis. Treatment with topical corticosteroids led to rapid improvement within 48 h.

Conclusion

This case highlights a rare adverse effect of dapagliflozin—DRESS syndrome—underscoring the importance of vigilance even with medications that typically have favorable safety profiles.