A Case of Allopurinol-Induced Drug Reaction with Eosinophilia and Systemic Symptoms in a Patient With Polycystic Kidney Disease and Chronic Kidney Disease.

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug hypersensitivity reaction.

Case presentation: A 59-year-old male with a history of stage IV chronic kidney disease, polycystic kidney disease, hypertension, and hyperuricemia on allopurinol presented to the emergency department directly from an outpatient nephrology appointment with concern for severe DRESS syndrome with acute-on-chronic kidney failure, liver failure, and pancreatic involvement.

Discussion: The existing literature on the course of DRESS syndrome in patients with preexisting kidney dysfunction is limited.

Conclusions: We report a case of DRESS syndrome in a patient with chronic kidney disease who presented after initiating allopurinol for hyperuricemia. Care should be taken to quickly identify DRESS, stop the offending agent, and initiate systemic corticosteroids to prevent long-term morbidity and mortality. Furthermore, patient counseling should emphasize follow-up to identify and treat potential long-term sequelae, including thyroiditis and cardiac disease.