{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:03:12Z","timestamp":1790622192419,"version":"4.1.0"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T00:00:00Z","timestamp":1627603200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T00:00:00Z","timestamp":1627603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Allergy Asthma Clin Immunol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening hypersensitivity reaction to medication. While a relatively rare phenomenon, early identification and discontinuation of the offending agent is pivotal to patient management. To our knowledge this is the first reported case of probable atorvastatin induced DRESS syndrome without rash.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>An adult female presented with 4\u00a0days of persistent fevers, abdominal and flank pain, malaise, and generalized muscle weakness without any cutaneous reaction following 20\u00a0days of therapy with atorvastatin. She was febrile (38.5\u00a0\u00b0C), at presentation with a heart rate of 72, and blood pressure of 93\/51\u00a0mmHg. Her laboratory investigations at their peak demonstrated an Alkaline Phosphatase (ALP) of 792 U\/L, Alanine aminotransferase (ALT) of 265 U\/L, gamma glutamyl transferase (GGT) of 236 U\/L, total bilirubin at 21\u00a0mg\/dL, eosinophils 3100 cells\/\u00b5L, leukocytes 20.2\u00a0K\/\u00b5L, hemoglobin of 12.5 gm\/dL. During her admission she had normal creatinine and troponin. Her serology for Hepatitis A, B and C were negative. Cytomegalovirus, Epstein-Barr viral serologies were negative. Antinuclear Antibody (ANA), rheumatoid factor, anti-neutrophil cytoplasmic antibody (ANCA), mitochondrial antibody, and smooth muscle antibody were negative. The patient was initially diagnosed as having pyelonephritis due to nonspecific bilateral flank pain but given ongoing fevers and lack of clinical and laboratory improvement with antibiotics, a diagnosis of atorvastatin induced DRESS syndrome was considered probable, and atorvastatin was discontinued. The patients\u2019 clinical status improved gradually without any further therapy and her liver enzymes and eosinophils normalized over the course of a month.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In patients who present with systemic organ involvement and eosinophilia, even without cutaneous manifestations, clinicians should apply the RegiSCAR criteria for DRESS syndrome. This can then help guide treatment with discontinuation of offending agent, or treatment with systemic corticosteroids.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13223-021-00581-y","type":"journal-article","created":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T08:05:54Z","timestamp":1627632354000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Liver enzyme elevation and eosinophilia with atorvastatin: a case of probable DRESS without cutaneous symptoms"],"prefix":"10.1186","volume":"17","author":[{"given":"Arman","family":"Zereshkian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Waserman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,30]]},"reference":[{"issue":"2","key":"581_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7759\/cureus.7098","volume":"12","author":"SF Mustafa","year":"2020","unstructured":"Mustafa SF, Zafar MR, Miller TW. Rosuvastatin use implicated in the drug reaction with eosinophilia and systemic symptoms. Cureus. 2020;12(2):1\u20136. https:\/\/doi.org\/10.7759\/cureus.7098.","journal-title":"Cureus"},{"key":"581_CR2","doi-asserted-by":"crossref","unstructured":"Lee H, Walsh S, Creamer D. Initial presentation of DRESS: often misdiagnosed as infections. 2012;148(9):1085\u20131087. https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/1359491.","DOI":"10.1001\/archdermatol.2012.1079"},{"issue":"5","key":"581_CR3","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1111\/bjd.12501","volume":"169","author":"SH Kardaun","year":"2013","unstructured":"Kardaun SH, Sekula P, Valeyrie-Allanore L, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013;169(5):1071\u201380. https:\/\/doi.org\/10.1111\/bjd.12501.","journal-title":"Br J Dermatol."},{"issue":"2","key":"581_CR4","doi-asserted-by":"publisher","first-page":"125","DOI":"10.4103\/ijd.IJD","volume":"63","author":"A De","year":"2018","unstructured":"De A, Rajagopalan M, Sarda A, Das S, Biswas P. Drug Reaction with Eosinophilia and Systemic Symptoms: An Update and Review of Recent Literature. Indian J Dermatol. 2018;63(2):125\u201330. https:\/\/doi.org\/10.4103\/ijd.IJD.","journal-title":"Indian J Dermatol"},{"issue":"3","key":"581_CR5","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1111\/j.1365-2133.2006.07704.x","volume":"156","author":"SH Kardaun","year":"2007","unstructured":"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? [20]. Br J Dermatol. 2007;156(3):609\u201311. https:\/\/doi.org\/10.1111\/j.1365-2133.2006.07704.x.","journal-title":"Br J Dermatol"},{"issue":"2","key":"581_CR6","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1002\/hep.27157.The","volume":"60","author":"MW Russo","year":"2014","unstructured":"Russo MW, Hoofnagle JH, Gu J, et al. The spectrum of statin hepatotoxicity: experience of the drug induced liver injury network. Hepatology. 2014;60(2):679\u201386. https:\/\/doi.org\/10.1002\/hep.27157.The.","journal-title":"Hepatology"},{"issue":"3","key":"581_CR7","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.alit.2019.03.006","volume":"68","author":"T Shiohara","year":"2019","unstructured":"Shiohara T, Mizukawa Y. Drug-induced hypersensitivity syndrome (DiHS)\/drug reaction with eosinophilia and systemic symptoms (DRESS): An update in 2019. Allergol Int. 2019;68(3):301\u20138. https:\/\/doi.org\/10.1016\/j.alit.2019.03.006.","journal-title":"Allergol Int"}],"container-title":["Allergy, Asthma &amp; Clinical Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-021-00581-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13223-021-00581-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-021-00581-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T08:09:31Z","timestamp":1627632571000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacijournal.biomedcentral.com\/articles\/10.1186\/s13223-021-00581-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,30]]},"references-count":7,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["581"],"URL":"https:\/\/doi.org\/10.1186\/s13223-021-00581-y","relation":{},"ISSN":["1710-1492"],"issn-type":[{"value":"1710-1492","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,30]]},"assertion":[{"value":"24 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The need for ethics approval was waived as per our institutional practice (Hamilton Integrated Research Ethics Board). Consent was obtained from the patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consent has been provided.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"No competing interest to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"81"}}