• Drug fever is diagnosis of exclusion

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)

• Drug fever 2/2 hypersensitivity
• Mortality 5-10%
• 2/2 acute liver failure, multi-organ failure, fulminant myocarditis, hemophagocytosis

Culprit drugs

• Allopurinol
• Phenytoin, carbamazepine, lamotrigine
• Bactrim, Vanc, Beta-lactam abx, minocycline, dapsone
• Sulfasalazine

Exam

• Skin rash (morbilliform or diffuse, confluent, infiltrated)
• Add pics
• Fever > 38C
• Facial edema
• Lymphadenopathy

Screen for systemic involvement/multi-organ failure

• LFTs, Cr, UA, CBC

• Withdraw offending agent
• Skin involvement - topical steroids (medium to high potency, e.g. triamcinolone)
• Organ involvement - PO steroids
• Supportive care