Fatal DRESS syndrome without eosinophilia after coronary artery bypass grafting

Abstract

Drug reaction with eosinophilia and systemic symptom (DRESS) is a life threatening adverse drug reaction. A 58-year-old female patient presented to our hospital with nausea and vomiting 2 weeks after elective coronary artery bypass grafting (CABG). She had used metoprololol, asetilsalycilic asit and furosemide after the operation. Blood tests showed neutropenia, low eosinophil levels, elevated liver biomarkers. Our case had fever, a morbilliform rash, bone marrow failure and hepatitis. Clinical (fever, exanthema, facial oedema) and laboratory (pansitopenia with liver and pulmonary involvement) findings raised the suspicion of DRESS and the patient was started on 1 mg/kg intravenous (IV) prednisone daily and IV immunoglobulin (IVIG) at 2 g/kg. She died on the the seventh ICU day. DRESS syndrome is a fatal drug hypersensitivity reaction with cutaneous and systemic involvements. Multidisciplinary care is important for a successful treatment.