DRESS Syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms)

DRESS syndrome stands for drug reaction with eosinophilia and systemic symptoms. It is a severe, delayed reaction to a medication. Eosinophilia means a high level of eosinophils, a type of white blood cell. "Systemic" means the reaction goes beyond the skin to affect internal organs. Typical signs include a widespread rash, fever, facial swelling, swollen lymph nodes, and inflammation of the liver, kidneys, lungs, or heart.

What makes DRESS dangerous is its timing. It usually appears weeks after starting a drug, not right away, so patients and doctors may not connect it to the medication. Anti-seizure drugs, certain antibiotics, and the gout drug allopurinol are among the medicines most often linked to it. The prescribing information for the anti-seizure drug Dilantin (phenytoin) lists DRESS, also called multiorgan hypersensitivity, as a warning and tells doctors to evaluate patients immediately if signs of hypersensitivity appear. Treatment starts with stopping the drug, and severe cases need hospital care.

DRESS is closely related to other severe drug reactions such as Stevens-Johnson syndrome. In litigation, DRESS claims are usually failure to warn product liability cases, arguing the label did not adequately describe the risk, or malpractice cases, arguing a doctor missed early signs or kept a patient on the drug too long. These are individual cases that depend on medical records and expert testimony.

If you or a family member developed DRESS, keep records showing when the drug started and stopped, lab results, and hospital records, and photograph the rash. Our mass tort guide explains how drug injury cases are organized.