{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:26:48Z","timestamp":1777955208282,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Case Rep"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>\n                    Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon but potentially fatal hypersensitivity response, commonly triggered by medications such as antiepileptics and antibiotics. It typically presents with rash, fever, hematologic abnormalities, lymphadenopathy, and internal organ involvement\u2014most commonly affecting the liver. We report a case of a 79-year-old woman with hypertension and dyslipidemia who underwent laparoscopic cholecystectomy for acute cholecystitis with early pancreatitis. Postoperatively, she developed persistent cholestatic liver injury without biliary obstruction. Ten days later, she presented with fatigue, a diffuse maculopapular rash, and elevated cholestatic liver enzymes and lipase. Skin biopsy revealed features consistent with drug-induced hypersensitivity. Using the RegiSCAR scoring system, the case met criteria for\n                    <jats:italic toggle=\"yes\">probable<\/jats:italic>\n                    DRESS syndrome (score\u2009=\u20095). Ceftriaxone and metronidazole, the only new drugs introduced perioperatively, were identified as likely triggers using the Naranjo causality scale. The patient was treated with oral prednisone (0.75\u2009mg\/kg), with full resolution of clinical and laboratory abnormalities following a 5-week course. This case highlights an atypical presentation of DRESS syndrome mimicking postoperative cholestasis. It underscores the importance of considering DRESS in the differential diagnosis of unexplained cholestatic injury, even in the absence of classical features like fever, eosinophilia, or lymphadenopathy. Early recognition and timely corticosteroid therapy are critical to improving outcomes.\n                  <\/jats:p>","DOI":"10.1177\/11795476251396593","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T05:15:52Z","timestamp":1764306952000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["DRESS Syndrome Mimicking Postoperative Cholestasis: A Case Report"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4670-7626","authenticated-orcid":false,"given":"Karim","family":"Zodeh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Balamand, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Attieh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Balamand, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa","family":"Mazraani","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Balamand, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussein","family":"Akil","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Balamand, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghinaj","family":"Daou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Balamand, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadira","family":"Diab","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Balamand, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1914-320X","authenticated-orcid":false,"given":"Karam","family":"Karam","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noha","family":"El Hachem","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.waojou.2022.100673"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.37349\/emed.2021.00037"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40278-024-56619-8"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.24150\/ajhm\/2021.014"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpge.2016.06.001"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2015.02.1130"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v7.i6.705"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.2174\/1381612825666191107161912"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.revmed.2013.02.034"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00204-023-03630-0"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.14309\/01.ajg.0000868512.17519.7d"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.4103\/2279-042X.137077"},{"key":"e_1_3_2_14_2","first-page":"433","article-title":"Use of the lymphocyte transformation test in the diagnosis of DRESS syndrome induced by ceftriaxone and piperacillin-tazobactam: two case reports","volume":"20","author":"Jurado-Palomo J","year":"2010","unstructured":"Jurado-Palomo J, Caba\u00f1as R, Prior N, et al. Use of the lymphocyte transformation test in the diagnosis of DRESS syndrome induced by ceftriaxone and piperacillin-tazobactam: two case reports. J Investig Allergol Clin Immunol. 2010;20:433-436.","journal-title":"J Investig Allergol Clin Immunol"},{"key":"e_1_3_2_15_2","article-title":"Metronidazole-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome with parvovirus B19 reactivation: a pediatric case","volume":"16","author":"Dridi B","year":"2024","unstructured":"Dridi B, Agrebi M, Sahnoun D, et al. Metronidazole-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome with parvovirus B19 reactivation: a pediatric case. Cureus. 2024;16:e62125.","journal-title":"Cureus"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-020-03005-9"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms18061243"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40278-024-53986-4"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40278-022-29066-2"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-023-04695-6"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2021.03.040"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10184287"}],"container-title":["Clinical Medicine Insights: Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476251396593","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11795476251396593","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476251396593","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:14:47Z","timestamp":1777454087000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11795476251396593"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":21,"alternative-id":["10.1177\/11795476251396593"],"URL":"https:\/\/doi.org\/10.1177\/11795476251396593","relation":{},"ISSN":["1179-5476","1179-5476"],"issn-type":[{"value":"1179-5476","type":"print"},{"value":"1179-5476","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]},"article-number":"11795476251396593"}}