Cefadroxil-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome After Double Mastectomy for Ductal Carcinoma In Situ - Case Report

Sep 28, 2026

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a delayed hypersensitivity reaction that begins with malaise and fever, then progresses to skin and hematologic changes with possible end-organ injury. Fewer than 3% of cases are linked to cephalosporins, yet a 43-year-old woman developed a diffuse erythematous, pruritic rash and systemic symptoms after prophylactic cefadroxil taken before double mastectomy for ductal carcinoma in situ. Symptoms worsened despite stopping the drug, and emergency evaluation showed fever, eosinophilia, and elevated liver enzymes, consistent with DRESS.

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Review began 09/28/2025 Review ended 11/24/2025 Published 12/01/2025 © Copyright 2025 Hazzard et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98209 Open Access Case Report Cefadroxil-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome After Double Mastectomy for Ductal Carcinoma In Situ: A Case Report Iyawnna Hazzard 1, Alexandra Hong 1 , Darius J. Shahbazi 2, Shahin Shahbazi 3 1. Department of Research, College of Medicine, California Northstate University, Elk Grove, USA 2. Division of Research, College of Osteopathic Medicine, Kansas City University, Kansas City, USA 3. Department of Hospital Medicine, Kaiser Roseville Medical Center, Sacramento, USA Corresponding author: Iyawnna Hazzard, [iyawnna.hazzard10630@cnsu.edu](iyawnna.hazzard10630@cnsu.edu) Abstract Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a delayed hypersensitivity reaction to medications, characterized by a prodrome of malaise and fever, followed by skin and hematologic manifestations and end-organ damage. Typical causal agents of DRESS syndrome include allopurinol, aromatic anticonvulsants, and antibiotics. However, fewer than 3% of cases suggest cephalosporin-induced DRESS syndrome. A 43-year-old female developed a diffuse, erythematous, pruritic rash encompassing her whole body after starting prophylactic cefadroxil therapy before a double mastectomy for ductal carcinoma in situ. Her rash continued to worsen despite discontinuation of cefadroxil and developed a fever, myalgias, and generalized weakness. In the emergency department, she was noted to be febrile (103 .5 °F) with elevated liver enzymes and eosinophilia, consistent with DRESS syndrome. She was admitted to medicine for further management with systemic steroids, intravenous fluids, and close observation. DRESS syndrome is a rare manifestation occurring after taking selected drugs. The signs and symptoms of DRESS syndrome may be indolent and persistent even after stopping the offending agent, as seen in this patient. Therefore, prompt treatment is necessary to prevent detrimental complications of the disease. Categories: Internal Medicine, Allergy/Immunology, Dermatology Keywords: cefadroxil, drug reaction with eosinophilia and systemic symptoms (dress), liver injury, rash, viral exanthem Introduction Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, delayed druginduced reaction. It is characterized by a prodrome of malaise, pruritus, fever greater than 38.5 °C, followed by skin manifestations, notably a morbilliform rash, facial edema, lymphadenopathy, hematologic manifestations, including atypical lymphocytes and eosinophilia, and end-organ damage involving the liver and kidney [1,2] . This reaction typically manifests two to eight weeks after drug exposure [3] . The true incidence of DRESS syndrome is uncertain due to its varying presentation, dependent on the medication itself and the patient’s immune status, which may result in many undiagnosed cases [1,4] . However, it is estimated that the incidence is greater than 1 case per 10,000 exposures to a medication [1] . One retrospective study found the prevalence of DRESS syndrome to be 2.18 per 100,000 [5] . DRESS syndrome is commonly caused by allopurinol and aromatic anticonvulsants, such as carbamazepine, lamotrigine, and phenobarbital [6] . Certain antibiotics are also a major contributor, especially vancomycin, sulfonamides, and antituberculosis agents, including isoniazid, rifampin, pyrazinamide, and ethambutol. However, cephalosporins were not found to be a significant contributor. One review found the prevalence of cephalosporin-induced DRESS syndrome to be 3.94%[6] . Other c

FAQs

What is DRESS syndrome and what does it typically involve?

DRESS syndrome is a severe delayed drug-induced hypersensitivity reaction. It presents with prodromal malaise and fever, followed by skin and hematologic manifestations such as eosinophilia, and can lead to end-organ damage including liver and kidney involvement.

How did the patient develop DRESS in this case?

A 43-year-old woman took prophylactic cefadroxil before a double mastectomy for ductal carcinoma in situ. After starting the medication, she later developed a diffuse pruritic rash that worsened even after cefadroxil was discontinued, along with fever, myalgias, and generalized weakness.

What findings supported the diagnosis in the emergency department?

The patient was febrile with elevated liver enzymes and eosinophilia. These findings, together with the clinical progression after cefadroxil exposure, were consistent with DRESS syndrome.

Sep 28, 2026

Uploaded by McQueen