A Rare Pediatric Case of Allopurinol-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Successfully Treated With Intravenous Immunoglobulins

Allopurinol-induced drug reaction syndrome with eosinophilia and systemic symptoms (A-DRESS) is a welldescribed condition in adults, whereas it is uncommon among children. We describe a case of A-DRESS in a 16-year-old male with steroid-dependent nephrotic syndrome. He presented a life-threatening clinical course with persisting fever, skin rash, eosinophilia, lymphadenopathy, distributive shock, and herpesvirus 6 detection. The withdrawal of allopurinol and a combination of intravenous immunoglobulins (IVIGs) and systemic corticosteroids led to the patient’s recovery without sequelae. Drug reaction with eosinophilia and systemic symptoms (DRESS) in pediatrics is rare and can present in a severe form. Early diagnosis and timely treatment are critical for prognostic purposes. This report suggests the potentially crucial role of IVIG in the treatment of patients with A-DRESS. ABBREVIATIONS ADR, adverse drug reaction; A-DRESS, allopurinol-induced drug reaction with eosinophilia and systemic symptoms; CRP, C-reactive protein; DRESS, drug reaction with eosinophilia and systemic symptoms; HHV6, human herpesvirus 6; IV, intravenous; IVIG, intravenous immunoglobulin; MP, methylprednisolone.