Surreal illustration of DRESS syndrome triggered by antibiotics.

DRESS Syndrome: When Antibiotics Backfire

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Beau Callahan in Health & Wellness December 2025 • 4 min read.

"A Case Study of Antibiotic-Induced Drug Reaction with Eosinophilia and Systemic Symptoms"


Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe adverse drug reaction that can affect multiple organ systems. It is characterized by a combination of symptoms, including fever, rash, eosinophilia (an elevated level of eosinophils, a type of white blood cell), and internal organ involvement such as liver, kidney, or lung damage.

Antibiotics, while life-saving in treating bacterial infections, can paradoxically trigger DRESS syndrome in some individuals. Identifying the causative antibiotic and managing the resulting systemic inflammation are critical for patient recovery. This article examines a case study that highlights the complexities of DRESS syndrome induced by multiple antibiotics.

This case study focuses on a woman in her thirties who developed DRESS syndrome following treatment with a variety of antibacterial medications. Her medical history included pneumococcal pneumonia and aortic valve endocarditis, requiring multiple interventions and long-term antibiotic therapy. The case illustrates the diagnostic challenges, the range of potential causative agents, and the importance of prompt recognition and management of DRESS syndrome.

Unraveling the Antibiotic Connection: A Complex Case of DRESS Syndrome

Surreal illustration of DRESS syndrome triggered by antibiotics.

The patient was initially admitted to the emergency department with complaints of right knee pain, fever, and chills. Her history revealed previous aortic valve replacement due to endocarditis, further complicated by septic emboli and vertebral abscess, mandating a Bentall procedure. Long-term antibiotic treatment was a constant in her medical journey.

Prior to the current admission, she had experienced a drug reaction with eosinophilia and systemic symptoms, which resolved with prednisone. Her medication list included benzylpenicillin, ceftriaxone, piperacillin/tazobactam, diclofenac, vancomycin, tramadol, and diclofenac.

  • Upon admission, she presented with knee joint swelling, tenderness, and a low-grade fever.
  • Initially, teicoplanin and moxifloxacin were administered with suspicion of graft infection, bacterial endocarditis, or arthritis.
  • Gastrointestinal symptoms arose, attributed to moxifloxacin, leading to a switch to intravenous ciprofloxacin.
  • A pruritic papular rash developed, resulting in the discontinuation of ciprofloxacin.
  • Despite stopping antibiotics, fever and eosinophilia returned, prompting treatment with meropenem due to concerns of persistent endocarditis or vascular graft infection.
  • The patient's condition continued to decline, with respiratory distress, haemodynamic instability, and a new rash. She required ICU admission and intubation for severe hypoxaemia.
Further investigations indicated kidney and liver involvement, and a PET-CT scan revealed bilateral pulmonary opacities and widespread lymphadenopathy. DRESS syndrome was diagnosed, and treatment with prednisone was initiated. Antibiotics were discontinued, leading to a gradual recovery. The patient was eventually discharged to a rehabilitation clinic and, after six months, to her home.

Key Takeaways: Navigating the Challenges of Antibiotic-Induced DRESS

This case highlights the difficulties in diagnosing DRESS syndrome, especially in patients with complex medical histories and multiple drug exposures. The overlapping symptoms with other conditions, such as infections, can delay diagnosis and appropriate management.

Identifying the specific causative drug can be challenging, as patients often receive multiple medications. In this case, several antibiotics were implicated, including teicoplanin, vancomycin and amoxicillin. Awareness of the potential for antibiotic-induced DRESS is crucial for clinicians.

Early recognition, prompt discontinuation of the causative drug, and initiation of systemic corticosteroids are essential for managing DRESS syndrome. This case underscores the importance of considering DRESS syndrome in patients presenting with fever, rash, eosinophilia, and organ involvement, particularly in the context of antibiotic use.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What is Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome?

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe adverse drug reaction. It manifests with a combination of symptoms, including fever, rash, eosinophilia (elevated eosinophils, a type of white blood cell), and internal organ involvement like liver, kidney, or lung damage. In this case, multiple antibiotics triggered DRESS syndrome, highlighting the complex interplay between medication and the body's immune response.

2

Why is DRESS syndrome important in this context?

In the context of this case, the patient developed DRESS syndrome due to the use of multiple antibacterial medications. Antibiotics, intended to treat bacterial infections, paradoxically triggered this severe reaction. The patient's complex medical history, including pneumococcal pneumonia and aortic valve endocarditis, meant she required multiple interventions and long-term antibiotic therapy, increasing her risk. The challenge lies in identifying the specific causative antibiotic among the several administered and effectively managing the resulting systemic inflammation.

3

What are the implications of developing DRESS syndrome?

The implications of DRESS syndrome, as demonstrated in this case, are significant. The delayed diagnosis, due to overlapping symptoms with other conditions, can lead to the worsening of the patient's condition. Internal organ involvement can lead to kidney, liver, or lung damage. The required treatment involves prompt recognition, discontinuation of the offending medication, and management of the systemic inflammation with corticosteroids like prednisone, which in this case, led to the patient's recovery. The patient's critical condition necessitated intensive care, including intubation.

4

What challenges are faced when diagnosing DRESS syndrome?

This case study highlights the challenges in diagnosing DRESS syndrome, especially in patients with complex medical histories. The patient's medical journey involved aortic valve replacement due to endocarditis, further complicated by septic emboli and vertebral abscess, mandating a Bentall procedure. This complex history and the use of numerous antibiotics, including benzylpenicillin, ceftriaxone, piperacillin/tazobactam, vancomycin, teicoplanin, moxifloxacin, ciprofloxacin, and meropenem, made it difficult to pinpoint the causative agent. The overlapping symptoms of fever, rash, and organ involvement added to the diagnostic complexity, potentially delaying appropriate treatment.

5

What is the significance of eosinophilia in DRESS syndrome?

The eosinophilia, an elevated level of eosinophils, is a key characteristic of DRESS syndrome. It's a sign of the body's immune system reacting to the drug. In this case, the patient showed elevated eosinophil levels, which, alongside fever, rash, and organ involvement, helped in the diagnosis of DRESS syndrome. The return of eosinophilia, even after stopping some antibiotics, emphasized the severity of the reaction and the need to identify and eliminate all contributing medications for effective management. The treatment with prednisone was crucial in controlling the systemic inflammation triggered by the immune response.

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