Fatal DRESS Syndrome Without Eosinophilia After Coronary Artery Bypass Grafting

Abstract

ABS TRACT Drug reaction with eosinophilia and systemic symptom (DRESS) is a life threatening adverse drug reaction. A 58-year-old female patient presented to our hospital with nausea and vomiting 2 weeks after elective coronary artery bypass grafting (CABG). She had used metoprololol, asetilsalycilic asit and furosemide after the oper- ation. Blood tests showed neutropenia, low eosinophil levels, elevated liver biomarkers. Our case had fever, a morbilliform rash, bone mar- row failure and hepatitis. Clinical (fever, exanthema, facial oedema) and laboratory (pansitopenia with liver and pulmonary involvement) findings raised the suspicion of DRESS and the patient was started on 1 mg/kg intravenous (IV) prednisone daily and IV immunoglobulin (IVIG) at 2 g/kg. She died on the the seventh ICU day. DRESS syndrome is a fatal drug hypersensitivity reaction with cutaneous and systemic involvements. Multidisciplinary care is important for a suc-cessful treatment.