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ISSN (Print): 2666-7967
ISSN (Online): 2666-7975

Case Report

Hydroxychloroquine Induced DRESS (Drug Rash with Eosinophilia and Systemic Symptoms Syndrome) Mimicking SARS-COV-2 Illness: A Case Report with Review

Author(s): Maitri M. Patel, Dhruvkumar M. Patel*, Mukundkumar V. Patel, Jayanti K. Gurumukhani, Suyog Y Patel and Harsh D. Patel

Volume 2, Issue 4, 2021

Published on: 29 September, 2020

Page: [521 - 526] Pages: 6

DOI: 10.2174/2666796701999200929123836


Background: In the current pandemic of COVID-19, hydroxychloroquine (HCQ) is recommended as an experimental drug for prophylaxis and treatment of the illness. Although it is a safe drug, it can rarely produce a severe drug reaction ‘drug rash with eosinophilia and systemic symptoms syndrome (DRESS)’, and to differentiate it from systemic viral infections is challenging.

Case Presentation: A 45-year old male nurse working in a COVID-19 ward consumed HCQ weekly for two weeks for prevention of SARS-COV-2 illness. He presented with fever, pruritic maculopapular palmar rash, cervical lymphadenopathy for 12 hours and was quarantined as a suspected COVID-19 case. His laboratory tests revealed lymphopenia, eosinophilia, atypical lymphocytes, raised liver enzymes along with IgM negative, IgG positive rapid antibody test of SARS-COV-2. However, his throat swabs for SARS-COV-2 by real-time PCR were negative on day 1 and 7. He was finally diagnosed as definite DRESS based on the RegiSCAR score of six. He responded to levocetirizine 5 mg OD and oral prednisolone 60 mg daily tapered over 7 days.

Conclusion: DRESS due to HCQ is ‘probable’, ‘of moderate severity’, and ‘not preventable’ adverse effect mimicking SARS-COV-2 illness.

Keywords: Hydroxychloroquine, DRESS, drug rash with eosinophilia and systemic symptoms, COVID-19, SARS-COV-2, DRESS syndrome.

Graphical Abstract
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