A Case of Fatal Drug Rash Eosinophilia and Systemic Symptoms from Allopurinol

Hypereosinophilia is a systemic condition that has several possible etiologies: allergies, medications, infectious, autoimmune or other systemic diseases, and finally idiopathic forms. Skin involvement seems to relate to subcutaneous inflammatory infiltration in this condition, as can be observed in parasitic, autoimmune and bullous diseases, as well as in drug reactions. Generalizing, a severe adverse drug-induced reaction may cause a systemic inflammatory disease: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS). Its diagnosis requires the application of a complex diagnostic algorithm and immediate identification to prevent inauspicious evolution. The prognosis is severe; drug discontinuation is sometimes not enough and so far the proposed therapies are not always valid. We describe a case of fatal DRESS in which we report: a) difficulties in the management and therapy of the syndrome in its most severe form, and b) need for caution in prescribing drugs potentially inducing DRESS, especially in elderly patients.