A Case Report of Co-trimoxazole Induced DRESS Syndrome

Authors

  • Tanachanan Kukongviriyapan Department of Medicine Samutsakhon Hospital
  • Walairat Sitthikornsawat Department of Medicine Samutsakhon Hospital

Keywords:

DRESS syndrome, Co-trimoxazole, HIV

Abstract

DRESS Syndrome is rare but severe and potentially life-threatening adverse drug reaction with only few cases report till date. We report a case of co-trimoxazole induced DRESS syndrome in a 40-year-old man with human immunodeficiency virus affected who presented with erythematous morbilliform rash on face, trunk and extremities with facial edema and systemic involvement after 4 weeks of initiation of co-trimoxazole and improvement on cessation of the drug

References

World Health Organization. Guidelines on co-trimoxazole prophylaxis for HIV-related infections among children, adolescents and adults in resourcelimited settings: recommendations for a public health approach. Geneve: WHO; 2006.

Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331(19):1272-85. doi: 10.1056/NEJM199411103311906.

Calle AM, Aguirre N, Ardila JC, Cardona Villa RC. DRESS syndrome: A literature review and treatment algorithm. World Allergy Organ J. 2023;16(3):100673. doi: 10.1016/j.waojou.2022.100673.

Bocquet H, Bagot M, Roujeau JC. Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Semin Cutan Med Surg. 1996;15(4):250-7. doi: 10.1016/s1085-5629(96)80038-1.

Paitorn L. Co-Trimoxazole-Induced DRESS Syndrome: A Case Report. J Med Assoc Thai. 2016;99(Suppl 2):S227-30. PMID: 27266243.

Carr A, Cooper DA. Pathogenesis and management of HIV-associated drug hypersensitivity. AIDS Clin Rev. 1995:65-97.

Rieder MJ, Shear NH, Kanee A, Tang BK, Spielberg SP. Prominence of slow acetylator phenotype among patients with sulfonamide hypersensitivity reactions. Clin Pharmacol Ther. 1991;49(1):13-7. doi: 10.1038/clpt.1991.3.PMID:1988235.

Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: Part I. Clinical perspectives. J Am Acad Dermatol. 2013;68(5):693.e1–693.e1-14. quiz 706-8. doi:10.1016/j.jaad.2013.01.033

Hess DA, Sisson ME, Suria H, Wijsman J, Puvanesasingham R, Madrenas J, et al. Cytotoxicity of sulfonamide reactive metabolites: apoptosis and selective toxicity of CD8+ cells by the hydroxylamine of sulfamethoxazole. FASEB J. 1999;13(13):1688-98.

Naisbitt DJ, Gordon S F, Pirmohamed M, Burkhart C, Cribb AE, Pichler WJ, et al. Antigenicity and immunogenicity of sulphamethoxazole: demonstration of metabolism‐dependent haptenation and T‐cell proliferation in vivo. B J Pharmacol. 2021;133(2):295-305.

Meyer C, Behm N, Brown E, Copeland NK, Sklar MJ. An Adverse Drug Reaction to Trimethoprim-Sulfamethoxazole Revealing Primary HIV: A Case Report and Literature Review. Case Rep Infect Dis. 2015;2015:691010. doi: 10.1155/2015/691010. Epub 2015 Dec 21.

Peter J, Choshi P, Lehloenya RJ. Drug hypersensitivity in HIV infection. Curr Opin Allergy Clin Immunol. 2019;19(4):272-82. doi: 10.1097/ACI.0000000000000545.

Kardaun SH, Sidoroff A, Valeyrie-Allanore L, et al. Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol. 2007;156(3):609-611.

Kuyucu S, Blanca-Lopez N, Caubet JC, Moral L, Sousa-Pinto B, Topal OY, et al. Clinical diagnosis and management of drug reaction with eosinophilia and systemic symptoms (DRESS) in children: An EAACI position paper. Pediatr Allergy Immunol. 2025;36(7):e70103. doi: 10.1111/pai.70103.

Martínez-Cabriales SA, Rodríguez-Bolaños F, Shear NH. Drug reaction with eosinophilia and systemic symptoms (DRESS): How far have we come? Am J Clin Dermatol. 2019;20(2):217-36.

Liccardo PC, Ingen-Housz-Oro S, Wolkenstein P, Wagner-Ballon O, Badaoui B. Diagnostic value of three complete blood count abnormalities, hypereosinophilia, hyperlymphocytosis and basophilic lymphocytes, in Drug Reaction with Eosinophilia and Systemic Symptoms. Br J Dermatol. 2025;192 (3):537-8.

Walsh S, Diaz-Cano S, Higgins E, Morris-Jones, Bashir S, Bernal W, Creamer D. Drug reaction with eosinophilia and systemic symptoms: is cutaneous phenotype a prognostic marker for outcome? A review of clinicalpathological features of 27 cases. Br J Dermatol. 2013;168(2):391-401.

Ortonne N, Valeyrie-Allanore L, Bastuji-Garin S, Wechsler J, De Feraudy, Duong TA, et al. Histopathology of drug rash with eosinophilia and systemic symptoms syndrome: a morphological and phenotypical study. Br J Dermatol. 2015;173(1):50-8

Bhatt NK, Belgaumkar VA, Chavan RB, Deshmukh NS. Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome with Toxic Epidermal Necrolysis: Overlap in an HIV Seropositive Male with Diffuse Large “B” Cell Lymphoma – A Rare Case Report. Clin Dermatol Rev. 2023;7(1):99-102. DOI: 10.4103/cdr.cdr_94_21

Ramírez-Marín HA, Domínguez-Cherit JD. " Virus Reactivation with Eosinophilia and Systemic Symptoms: An Imitator of Immune Reconstitution Inflammatory Syndrome with an Excellent Clinical Response to Valganciclovir." Actas dermosifiliog. 2023;114(3):T841-T843.

Wang, S., Kang, Y., He, C., & Jin, H. (2024). The systemic treatments for drug reaction with eosinophilia and systemic symptoms (DRESS) beyond corticosteroids. World Allergy Organ J. 2024;17(8): 100935. doi.org/10.1016/j.waojou.2024.100935

Brandariz D, Smithson A, Anton-Vazquez V. Drug reaction with eosinophilia and systemic symptoms related to antiretroviral treatment in human immunodeficiency virus patients. Indian J Sex Transm Dis AIDS. 2017;38(2):163-70.

Akerlund B, Tynell E, Bratt G, Bielenstein M, Lidman C. N-acetylcysteine treatment and the risk of toxic reactions to trimethoprimsulphamethoxazole in primary Pneumocystis carinii prophylaxis in HIVinfected patients. J Infect. 1997;35(2):143-7. doi: 10.1016/s0163-4453(97)91578-4.

Kano Y, Ushigome Y, Horie C, Mizukawa Y, Shiohara T. Immune reconstitution inflammatory syndrome observed in the setting of druginduced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS). Clin Transl Allergy. 2014;4(Suppl 3):148. doi: 10.1186/2045-7022-4-S3-P148

Chen YC, Chang CY, Cho YT, Chiu HC, Chu CY. Long-term sequelae of drug reaction with eosinophilia and systemic symptoms: a retrospective cohort study from Taiwan. J Am Acad Dermatol. 2013;68(3):459-65.

Choudhary, S., McLeod, M., Torchia, D., & Romanelli, P. (2013). Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. J Clin Aesthet Dermatol. 2013;6(6):317.

Gilbert DN, Chambers HF, Saag MS, Pavia AT, Boucher HW, Black D, et al. The Sanford guide to antimicrobial therapy 2023. 53rd ed. Birmingham (AL): Antimicrobial Therapy; 2023.

Downloads

Published

2026-03-31

How to Cite

Kukongviriyapan, T., & Sitthikornsawat, W. (2026). A Case Report of Co-trimoxazole Induced DRESS Syndrome. Health Science and Nursing Samutsakhon Hospital Journal, 2(2), 123–138. retrieved from https://he05.tci-thaijo.org/index.php/HSN_SKHJ/article/view/7694

Issue

Vol. 2 No. 2 (2025): July-December 2025

Section

Case Study

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Articles in this journal are copyrighted by the x may be read and used for academic purposes, such as teaching, research, or citation, with proper credit given to the author and the journal.
use or modification of the articles is prohibited without permission.
statements expressed in the articles are solely the opinions of the authors.
authors are fully responsible for the content and accuracy of their articles.
other reuse or republication requires permission from the journal."