Thyroid dysfunction in drug reaction with eosinophilia and systemic symptoms (DRESS): An unusual manifestation of systemic drug hypersensitivity

摘要

Madam, A 46-year-old Zimbabwean woman was admitted to hospital acutely unwell with fever and malaise, 4 weeks after commencing sulfasalazine treatment for a suspected nondiffer-entiated inflammatory arthropathy. Examination revealed marked facial oedema with visibly jaundiced sclera. There were sheets of micropustules over the cheeks and neck. Extending over the trunk and limbs was a widespread urti-cated erythema with multiple discrete atypical targetoid lesions (Fig. 1). Cervical and axillary lymphadenopadiies were palpable bilaterally. Biochemistry confirmed deranged liver function tests with transaminitis and elevated bilirubin. A full blood count revealed a raised eosinophil count of 6.18 X 10~9cells IT~-1 and an initial lymphocytopenia of 0.67 X 10~9 cells L~-1 with atypical lymphocytes visible on a blood film. A viral hepatitis screen and serology for Epstein-Barr virus, cytomegalovirus and human immunodeficiency virus were negative, and imaging of the liver revealed only mild fatty infiltration. A full septic screen revealed no focus of infection.