Gemcitabine-Induced Drug Rash With Eosinophilia and Systemic Symptoms (DRESS Syndrome) - A Case Report

Sep 28, 2026

Uploaded by Levi

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare, severe hypersensitivity reaction marked by fever, diffuse cutaneous eruption, hematologic abnormalities—especially eosinophilia—and multiorgan involvement, predominantly hepatic. Although classically linked to anticonvulsants, allopurinol, and sulfonamides, DRESS can be triggered by antineoplastic agents. This report describes a 46-year-old man with nasopharyngeal carcinoma who developed fever, rash, eosinophilia, and hepatic cytolysis after gemcitabine-based chemotherapy, improving after drug discontinuation and corticosteroids.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Introduction

Case Presentation

Clinical background

Timeline after chemotherapy

Key laboratory findings

Discussion

Conclusion

Review began 10/28/2025 Review ended 11/10/2025 Published 12/01/2025 © Copyright 2025 Ait Elfaqir 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.98273 Open Access Case Report Gemcitabine-Induced Drug Rash With Eosinophilia and Systemic Symptoms (DRESS Syndrome) : A Case Report Sara Ait Elfaqir 1, Othmane Zouiten 2, Leila Afani 3, Mohamed El Fadli 1, Rhizlane Belbaraka 1 1. Department of Medical Oncology, Mohammed VI University Hospital, Marrakesh, MAR 2. Department of Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Cadi Ayyad University, Marrakesh, MAR 3. Department of Oncology, Mohammed VI University Hospital, Marrakesh, MAR Corresponding author: Othmane Zouiten, [drzouitenothmane@gmail.com](drzouitenothmane@gmail.com) Abstract Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare, severe, and potentially lifethreatening hypersensitivity reaction characterized by fever, diffuse cutaneous eruption, hematologic abnormalities, most notably eosinophilia, and multiorgan involvement, predominantly hepatic. While classically associated with anticonvulsants, allopurinol, or sulfonamides, this syndrome may occasionally be triggered by antineoplastic agents. Gemcitabine, a nucleoside analogue with a generally favorable safety profile, is widely used in the treatment of various solid tumors. However, exceptional cases of severe immune-mediated cutaneous adverse drug reactions, including DRESS, have been described. We report the case of a 46-year-old man treated for nasopharyngeal carcinoma, who developed a febrile maculopapular rash with eosinophilia and hepatic cytolysis following gemcitabine-based chemotherapy. The diagnosis of DRESS was established according to RegiSCAR criteria, and clinical improvement was achieved after discontinuation of gemcitabine and corticosteroid therapy. This observation emphasizes the importance of early recognition of atypical hypersensitivity reactions during chemotherapy and the need for immediate drug withdrawal to prevent potentially severe complications. Categories: Pharmacology, Oncology, Dermatology Keywords: chemotherapy toxicity, dress syndrome, drug-induced hypersensitivity, gemcitabine, pharmacovigilance Introduction Therapeutic advances in oncology have led to the increasing use of chemotherapeutic agents with more manageable toxicity profiles, among which gemcitabine holds a prominent place. This nucleoside analogue is widely incorporated into treatment protocols for solid tumors such as pancreatic and lung adenocarcinomas, as well as certain sarcomas. Its adverse effects are generally well characterized, predominantly hematologic or infectious, while cutaneous reactions remain rare and usually mild. However, severe immune-mediated toxicities may occasionally occur. Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) is one of the most serious delayed hypersensitivity reactions, defined by fever, widespread rash, hematologic abnormalities, particularly eosinophilia, and multiorgan involvement, most frequently hepatic. According to a large literature review including 172 cases, DRESS carries a mortality rate of up to 10%, and its diagnosis is now standardized through the RegiSCAR scoring system, which stratifies cases as possible, probable, or definite [1] . While DRESS is classically associated with anticonvulsants, allopurinol, and sulfonamides, it may also be triggered by agents not traditionally considered high-risk. In this context, we report a rare case of gemcitabine-induced DRESS syndrome, highlighting the importance of early recognition of atypical febrile rashes during chemotherapy and the need for prompt management to prevent severe complications.

FAQs

What is DRESS syndrome, and what are its hallmark features?

DRESS is a rare, severe hypersensitivity reaction characterized by fever, diffuse cutaneous rash, hematologic abnormalities with eosinophilia, and multiorgan involvement, most commonly hepatic.

How did the patient develop DRESS after chemotherapy in this case?

Fifteen days after receiving the first gemcitabine and cisplatin cycle he developed a mild rash. Two days after the second cycle he was admitted with a generalized pruritic maculopapular rash and fever, with subsequent eosinophilia and hepatic cytolysis.

How was the diagnosis established and what treatment led to improvement?

The diagnosis of DRESS was made using the RegiSCAR criteria. Clinical improvement occurred after discontinuing gemcitabine and starting corticosteroid therapy.

Sep 28, 2026

Uploaded by Levi