{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T14:56:12Z","timestamp":1767970572561,"version":"3.49.0"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,9,10]],"date-time":"2013-09-10T00:00:00Z","timestamp":1378771200000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Dermatology"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Drug rash with eosinophilia and systemic symptoms (<jats:styled-content style=\"fixed-case\">DRESS<\/jats:styled-content>) is a severe drug\u2010induced hypersensitivity syndrome that presents with diffuse cutaneous eruptions, fever, and multiorgan involvement. Here we present a pediatric case of <jats:styled-content style=\"fixed-case\">DRESS<\/jats:styled-content> complicated by human herpesvirus (<jats:styled-content style=\"fixed-case\">HHV<\/jats:styled-content>)\u20106 reactivation. After 1\u00a0week of sulfasalazine, our patient developed a diffuse morbilliform eruption. Sulfasalazine was discontinued. The patient presented to the emergency department soon thereafter with worsening eruption, fever, rigors, facial edema, and lymphadenopathy. Methylprednisolone was initiated. Peripheral smear did not demonstrate eosinophilia but showed toxic granulation with atypical lymphocytes. Transaminase levels and white blood cell count quickly became elevated, with increased eosinophils, suggesting <jats:styled-content style=\"fixed-case\">DRESS<\/jats:styled-content>. During the methylprednisolone taper, our patient experienced symptom exacerbation, acute hepatitis, and <jats:styled-content style=\"fixed-case\">HHV<\/jats:styled-content>\u20106 seroconversion, indicating <jats:styled-content style=\"fixed-case\">HHV<\/jats:styled-content>\u20106 reactivation as the cause. As demonstrated by our patient, a decelerated methylprednisone taper is important because of potential symptom flaring during taper. Additionally, in the care of individuals with <jats:styled-content style=\"fixed-case\">DRESS<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> HHV<\/jats:styled-content>\u20106 is often tested for upon admission and not repeated. Delay in the rise of titers necessitates repeat testing.<\/jats:p>","DOI":"10.1111\/pde.12204","type":"journal-article","created":{"date-parts":[[2013,9,11]],"date-time":"2013-09-11T06:28:39Z","timestamp":1378880919000},"page":"608-613","source":"Crossref","is-referenced-by-count":12,"title":["Case Report of Drug Rash with Eosinophilia and Systemic Symptoms Demonstrating Human Herpesvirus\u20106 Reactivation"],"prefix":"10.1111","volume":"30","author":[{"given":"Natalie A.","family":"Ferrero","sequence":"first","affiliation":[{"name":"Department of Dermatology School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly C.","family":"Pearson","sequence":"additional","affiliation":[{"name":"Department of Dermatology School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel C.","family":"Zedek","sequence":"additional","affiliation":[{"name":"Department of Pathology School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean S.","family":"Morrell","sequence":"additional","affiliation":[{"name":"Department of Dermatology School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,9,10]]},"reference":[{"key":"e_1_2_3_2_1","article-title":"Allopurinol\u2010induced DRESS syndrome with a histologic pattern consistent with interstitial granulomatous drug\u2010reaction","author":"Kim MS","year":"2013","journal-title":"Am J 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eosinophilia and systemic symptoms","volume":"137","author":"Descamps V","year":"2001","journal-title":"Arch Dermatol"},{"key":"e_1_2_3_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.140.2.183"},{"key":"e_1_2_3_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tox.2004.12.013"},{"key":"e_1_2_3_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2008.01785.x"},{"key":"e_1_2_3_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2011.01.017"},{"key":"e_1_2_3_14_1","doi-asserted-by":"publisher","DOI":"10.1684\/ejd.2010.0821"},{"key":"e_1_2_3_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.134.9.1113"},{"key":"e_1_2_3_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.134.9.1108"},{"key":"e_1_2_3_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e318125655d"},{"key":"e_1_2_3_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2009.01660.x"},{"key":"e_1_2_3_19_1","first-page":"510","article-title":"Case 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