Dress Syndrome in the Aged: A Differential Diagnosis to be Considered

Abstract

OBJECTIVES: To describe and discuss a rare adverse reaction to drugs diagnosed in an elderly female patient after using levofloxacin and metronidazole: the DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms). CASE DESCRIPTION: A 77-year-old elderly woman was diagnosed with pneumonia. After undergoing treatment with metronidazole and levofloxacin, she developed pruritic skin lesions, eosinophilia, and fever. INVESTIGATIONS: We established a suspected diagnosis of levofloxacin-induced DRESS syndrome, and therefore we switched the antibiotics and then administered corticotherapy. The patient exhibited rapid and progressive improvement without damage to other organs. DIFFERENTIAL DIAGNOSIS: Conditions involving eosinophilia, drug hypersensitivity, and/or skin rash. COMMENTS: This syndrome is characterized by skin eruption, systemic symptoms, and eosinophilia. Although the patient did not meet all clinical criteria in the literature, the lack of consensus among authors means that a DRESS syndrome diagnosis could not be ruled out. The condition is rare, but clinicians should be alert to this diagnosis in aged individuals, given its severity and high risk of mortality.

Keywords

• drug hypersensitivity syndrome
• aged
• evofloxacin