UMEM Educational Pearls

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) or DIHS (Drug-Induced Hypersensitivity Syndrome) is a potentially life-threatening adverse drug-reaction.

Incidence is 1/1,000 to 1/10,00 drug exposures. It occurs 2-6 weeks after the drug is first introduced, distinguishing it from other adverse drug-reactions which typically occur sooner.

The syndrome classically includes:

  • Severe skin eruptions (typically morbilliform or erythrodermic eruptions)
  • Hematologic abnormalities (eosinophilia or atypical lymphocytosis)
  • Organ involvement; e.g., hepatic (most common), pneumonitis, renal failure, etc.
  • Fevers
  • Arthralgia
  • Lymphadenopathy

The most commonly implicated drugs are anticonvulsants (e.g., carbamazepine, phenobarbital, and phenytoin), sulfonamides, and allopurinol. 

Recovery is typically complete after discontinuing the offending drug; systemic steroids may promote resolution of the illness.


Cacoub P. et al. The DRESS syndrome: a literature review. Am J Med 2011 Jul;124(7):588-97.

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