Drug reaction with eosinophilia and systemic symptoms (DRESS) successfully treated with tumor necrosis factor-α inhibitor

Drug reaction with eosinophilia and systemic symptoms (DRESS), also referred to as drug-induced hypersensitivity syndrome is a rare, potentially life-threatening adverse drug reaction characterized by rash with fever, lymphadenopathy, hematologic abnormalities such as eosinophilia or atypical lymphocytes, and internal organ involvement. DRESS occurs within 2 to 6 weeks after the beginning of the pharmacologic treatment.1 Treatment of DRESS consists of stopping the offending medication and providing supportive care. The use of systemic steroids remains controversial because the etiology of the rash is unknown and the use of systemic corticosteroids has associated risks.2 Recently, tumor necrosis factor (TNF)-α as a pro-inflammatory mediator has attracted the clinician's attention. Over the last decade, TNF-α inhibitors, such as infliximab and etanercept, have been used to treat toxic epidermal necrolysis (TEN) and Stevens Johnson syndrome (SJS), with anecdotal success.3, 4 However, to our knowledge, there is no report yet on whether a TNF-α inhibitor is effective to treat DRESS. Here we present a case of DRESS associated with lithium carbonate successfully treated with a TNF-α inhibitor (Recombinant Human TNF Receptor-IgG Fusion Protein; Qiangke, Celgen Biopharmaceutical Co, Ltd. Shanghai, China).