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may resemble SJS) are typically first signs Usually urticarial, maculopapular eruption In some cases vesicles, bullae, pustules, purpura, target lesions, facial edema, cheilitis, erythroderma +/- lymphadenopathy Systemic involvement may manifest as hepatitis, pneumonitis, myocarditis, pericarditis, nephritis, colitis Atypical lymphocytes, thrombocytopenia, neutropenia, anemia Leukocytosis with eosinophilia in 50-90%, and mononucleosis in 40% [3] [4] Differential Diagnosis Erythematous rash Positive Nikolsky’s sign Febrile Staphylococcal scalded skin syndrome (children) Toxic epidermal necrolysis/SJS (adults) Afebrile Toxic epidermal necrolysis Negative Nikolsky’s sign Febrile Toxic shock syndrome Kawasaki disease Scarlet fever DRESS syndrome Cellulitis Acute generalized exanthematous pustulosis Afebrile Alcohol intoxication Anaphylaxis Cellulitis Dermatitis (multiple types) Drug rash Erysipelas Erythema multiforme Exfoliative erythroderma Scombroid Vancomycin infusion reaction Evaluation Workup CBC with diff BMP LFTs Coags ESR CRP Viral hepatitis panel Biopsy Diagnosis Table of Severe Drug Rashes Management Discontinue suspected drug Supportive care: antipyretic, anti-pruritic Fluid management as in burn Systemic steroids and/or cyclosporin/immunosuppressants in severe cases (controversial) Hepatitis, pneumonitis, extensive exfoliative dermatitis Other severe systemic manifestations Family counseling as possible genetic component Disposition Admit See Also Erythematous rash External Links Medscape - Drug Erruptions The DRESS Syndrome: The Great Clinical Mimicker References ↑ Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome
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