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Drug reaction with eosinophilia and systemic symptoms (DRESS) associated with azithromycin in acute Epstein-Barr

Kimberly A Bauer1, Angela K Brimhall2, Timothy T Chang1

  • 1Department of Dermatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.

Pediatric Dermatology
|October 21, 2011
PubMed

Insights

A rare drug reaction with eosinophilia and systemic symptoms (DRESS) occurred in a child treated with azithromycin during an Epstein-Barr virus infection. Prompt recognition of DRESS syndrome is crucial for pediatric patients.

Area of Science:

  • Pediatric Medicine
  • Pharmacovigilance
  • Infectious Diseases

Background:

  • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe hypersensitivity reaction.
  • Azithromycin is a commonly prescribed antibiotic, particularly in pediatric populations.
  • Acute Epstein-Barr virus (EBV) infection is prevalent in children and adolescents.

Observation:

  • An 8-year-old boy developed DRESS following azithromycin administration for acute EBV infection.
  • Clinical manifestations included fever, rash, eosinophilia, and hypotension.
  • The patient required intensive care unit admission due to the severity of symptoms.

Findings:

  • This case represents the first reported pediatric DRESS associated with azithromycin during an EBV infection.
  • The patient recovered fully without long-term complications after supportive care.
  • Highlights the potential for severe drug reactions even with common antibiotics in the context of viral infections.

Implications:

  • Emphasizes the need for careful consideration of antibiotic use in patients with acute viral infections like EBV.
  • Underscores the importance of recognizing DRESS syndrome's clinical signs for timely intervention in pediatric cases.
  • Suggests a potential interaction between azithromycin and EBV infection leading to severe hypersensitivity reactions.

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