{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T21:52:55Z","timestamp":1772401975505,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:00:00Z","timestamp":1700784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":",,Dunarea de Jos University of Medicine and Pharmacy Galati, Romania","award":["no nr"],"award-info":[{"award-number":["no nr"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug reaction commonly related to eosinophilia, from uncertain epidemiology, and without consensus for diagnosis and treatment globally. It presents a great challenge in its management and is characterized by fever, lymphadenopathy, skin rash, and multisystemic involvement. An aggressive and difficult-to-manage clinical case is presented in a 50-year-old man with chronic kidney disease due to diabetes mellitus type 2 and systemic arterial hypertension, who developed an unusual variant similar to DRESS and Stevens\u2013Johnson syndrome (SJS) overlap secondary to allopurinol, with skin manifestations without eosinophilia, but fulfilling clinical and laboratory criteria for DRESS and SJS syndrome.<\/jats:p>","DOI":"10.3390\/life13122251","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T06:51:28Z","timestamp":1700808688000},"page":"2251","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["DRESS and Stevens\u2013Johnson Syndrome Overlap Secondary to Allopurinol in a 50-Year-Old Man\u2014A Diagnostic and Treatment Challenge: Case Report"],"prefix":"10.3390","volume":"13","author":[{"given":"Jos\u00e9 Dario","family":"Mart\u00ednez","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Hospital Universitario Jos\u00e9 Eleuterio Gonz\u00e1lez, University Autonomous of Nuevo Le\u00f3n, Monterrey 66455, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6853-8726","authenticated-orcid":false,"given":"Rodolfo","family":"Franco","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Faculty of Medicine, Hospital Universitario Jos\u00e9 Eleuterio Gonz\u00e1lez, University Autonomous of Nuevo Le\u00f3n, Monterrey 66455, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Manuel","family":"S\u00e1enz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Hospital Jos\u00e9 Eleuterio Gonz\u00e1lez, University Autonomous of Nuevo Le\u00f3n, Monterrey 66455, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Americo Guadalupe","family":"Alvarado","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Hospital Universitario Jos\u00e9 Eleuterio Gonz\u00e1lez, University Autonomous of Nuevo Le\u00f3n, Monterrey 66455, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8995-5756","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Faculty of Medicine, Hospital Universitario Jos\u00e9 Eleuterio Gonz\u00e1lez, University Autonomous of Nuevo Le\u00f3n, Monterrey 66455, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio M\u00e1ximo","family":"Delgado","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Hospital Jos\u00e9 Eleuterio Gonz\u00e1lez, University Autonomous of Nuevo Le\u00f3n, Monterrey 66455, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2569-8527","authenticated-orcid":false,"given":"Marius-Anton","family":"Ionescu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Hospital Saint Louis, 63110 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camelia","family":"Busil\u0103","sequence":"additional","affiliation":[{"name":"Clinical Medical Department, Faculty of Medicine and Pharmacy, \u201cDunarea de Jos\u201d University, 800008 Galati, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4290-7068","authenticated-orcid":false,"given":"Alin Laurentiu","family":"Tatu","sequence":"additional","affiliation":[{"name":"Clinical Medical Department, Faculty of Medicine and Pharmacy, \u201cDunarea de Jos\u201d University, 800008 Galati, Romania"},{"name":"Dermatology Department, \u201cSfanta Cuvioasa Paraschiva\u201d Hospital of Infectious Diseases, 800179 Galati, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"577","DOI":"10.4067\/S0034-98872015000500004","article-title":"Reacci\u00f3n por drogas con eosinofilia y s\u00edntomas sist\u00e9micos (s\u00edndrome de DRESS): Estudio retrospectivo de nuevecasos","volume":"143","author":"Ocampo","year":"2015","journal-title":"Rev. Med. Chile"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"229","DOI":"10.18176\/jiaci.0480","article-title":"Spanish Guidelines forDiagnosis, Management, Treatment, and Prevention of DRESS Syndrome","volume":"30","author":"Sendagorta","year":"2020","journal-title":"J. Invest. Aller. Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1111\/jdv.18100","article-title":"Skin manifestations and clinical features of drug reaction with eosinophilia and systemic symptoms: A retrospective multicentre study of 125 patients","volume":"36","author":"Lee","year":"2022","journal-title":"J. Eur. Acad. Dermatol. Ven."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"14","DOI":"10.29262\/ram.v61i1.16","article-title":"Prevalence of DRESS syndrome","volume":"61","author":"Blancas","year":"2014","journal-title":"Rev. Alerg. Mex."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.clindermatol.2020.06.008","article-title":"Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome","volume":"38","author":"Cardones","year":"2020","journal-title":"Clin. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1007\/s00403-021-02274-3","article-title":"Characterizing DRESS syndrome recurrence a systematic review","volume":"314","author":"Sharma","year":"2022","journal-title":"Arch. Dermatol. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1007\/s12325-017-0530-y","article-title":"Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Concise Review with a Comprehensive Summary of Therapeutic Interventions Emphasizing Supportive Measures","volume":"34","author":"Schneider","year":"2017","journal-title":"Adv. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jdin.2023.06.014","article-title":"Epidemiology of Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States and factors predictive of outcome","volume":"13","author":"Wasuwanich","year":"2023","journal-title":"JAAD Int."},{"key":"ref_9","unstructured":"Burks, A.W., O\u2019Hehir, R.E., Broide, D.H., Holgate, S.T., Bacharier, L.B., Hershey, G.K.K., and Peebles, R.S. (2020). Middleton\u2019s Allergy: Principles and Practice, Elsevier."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.amjmed.2011.01.017","article-title":"The DRESS syndrome: A literature review","volume":"124","author":"Cacoub","year":"2011","journal-title":"Am. J. Med."},{"key":"ref_11","first-page":"1155","article-title":"Drug-Induced Hypersensitivity Syndrome (DIHS)\/Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Clinical Features and Pathogenesis","volume":"10","author":"Hama","year":"2022","journal-title":"J. Aller. Clin. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1080\/17843286.2020.1767459","article-title":"Drug reaction with eosinophilia and systemic symptoms (DRESS) induced by phenytoin re-exposure: Case report and systematic review","volume":"77","author":"Alva","year":"2022","journal-title":"Clin. Belg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/bjd.12081","article-title":"Drug reaction with eosinophilia and systemic symptoms:is cutaneous phenotype a prognostic marker for outcome? A review of clinicopathological features of 27 cases","volume":"168","author":"Walsh","year":"2013","journal-title":"Br. J. Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Jevtic, D., Dumic, I., Nordin, T., Singh, A., Sulovic, N., Radovanovic, M., Jecmenica, M., and Milovanovic, T. (2021). Less Known Gastrointestinal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of the Literature. J. Clin. Med., 10.","DOI":"10.3390\/jcm10184287"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2478\/acph-2023-0013","article-title":"Adverse drug reactions in the ambulatory internal patients at the emergency department: Focus on causality assessment and drug-drug interactions","volume":"73","author":"Brvar","year":"2023","journal-title":"Acta Pharm."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1097\/MJT.0000000000000569","article-title":"Bullous Reactions Associated With COX-2 Inhibitors","volume":"24","author":"Tatu","year":"2017","journal-title":"Am. J. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Cho, Y.T., Yang, C.W., and Chu, C.Y. (2017). Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18061243"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1111\/jcpt.13738","article-title":"Clinical features, diagnosis and management of cephalosporin-induced acute generalized exanthematous pustulosis","volume":"47","author":"Lei","year":"2022","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e15391","DOI":"10.1111\/dth.15391","article-title":"Cutaneous adverse reactions of COVID-19 vaccines: A systematic review","volume":"35","author":"Qaderi","year":"2022","journal-title":"Dermatol. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.jaad.2021.04.020","article-title":"Discriminating minor and major forms of drug reaction with eosinophilia and systemic symptoms: Facial edema aligns to the severe phenotype","volume":"85","author":"Momen","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1684\/ejd.2011.1550","article-title":"Identifying prognostic factors for drug rash with eosinophilia and systemic symptoms (DRESS)","volume":"21","author":"Wei","year":"2011","journal-title":"Eur. J. Dermatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.jaad.2018.08.052","article-title":"Drug-induced hypersensitivity syndrome\/drug reaction with eosinophilia and systemic symptoms severity score: A useful tool for assessing disease severity and predicting fatal cytomegalovirus disease","volume":"80","author":"Mizukawa","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1138464","DOI":"10.3389\/fmed.2023.1138464","article-title":"First-line therapy in drug reaction with eosinophilia and systemic symptoms (DRESS): Thinking beyond corticosteroids","volume":"10","author":"Verstegen","year":"2023","journal-title":"Front. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.anai.2021.08.012","article-title":"Successful treatment of corticosteroid-dependent drug reaction with eosinophilia and systemic symptoms with cyclosporine","volume":"127","author":"Su","year":"2021","journal-title":"An. Aller. Asthma Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s40257-023-00776-6","article-title":"Systemic Versus Topical Corticosteroids in the Treatment of DRESS: A Retrospective Cohort Study Followed by a Meta-Analysis","volume":"24","author":"Lian","year":"2023","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.annder.2021.02.002","article-title":"Impact of systemic to topical steroids switch on the outcome of drug reaction with eosinophilia and systemic symptoms (DRESS): A monocenter retrospective study of 20 cases","volume":"148","author":"Brin","year":"2021","journal-title":"Ann. Dermatol. Ven."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.jaad.2021.03.075","article-title":"Clinical, biochemical, and sero-logic predictors of drug reaction with eosinophilia and systemic symptoms syndrome: A prospective case-control study","volume":"85","author":"Choudhary","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000475802","article-title":"Overlapping DRESS and Stevens-Johnson Syndrome: Case Report and Review of the Literature","volume":"9","author":"Casagranda","year":"2017","journal-title":"Case Rep. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"98","DOI":"10.5021\/ad.2016.28.1.98","article-title":"Piperacillin\/tazobactam-associated hypersensitivity syndrome with overlapping features of acute generalized exanthematous pustulosis and drug-related rash with eosinophilia and systemic symptoms syndrome","volume":"28","author":"Kim","year":"2016","journal-title":"Ann. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/1750-1172-7-72","article-title":"Toxic epidermal necrolysis, DRESS, AGEP: Do overlap cases exist?","volume":"7","author":"Bouvresse","year":"2012","journal-title":"Orphanet. J. Rare Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1111\/bjd.14451","article-title":"Two cases of overlap severe cutaneous adverse reactions to benznidazole treatment for asymptomatic Chagas disease in a nonendemic country","volume":"175","author":"Tong","year":"2016","journal-title":"Br. J. Dermatol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/12\/2251\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:29:15Z","timestamp":1760131755000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/12\/2251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,24]]},"references-count":31,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["life13122251"],"URL":"https:\/\/doi.org\/10.3390\/life13122251","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,24]]}}}