When Autoimmunity 'DRESSes up': A Case after Certolizumab Therapy

Area of Science:

• Rheumatology
• Dermatology
• Clinical Pharmacology

Background:

• Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) presents with rash, organ involvement, and specific blood abnormalities.
• Diagnosis of DRESS syndrome is challenging due to its clinical heterogeneity.
• DRESS syndrome has a significant mortality rate (2-10%) and an incidence of 2 per 100,000.

Purpose of the Study:

• To report the first case of DRESS syndrome induced by certolizumab.
• To emphasize the diagnostic challenges associated with DRESS syndrome.
• To raise awareness among clinicians regarding drug-induced hypersensitivity reactions.

Main Methods:

• Case report of a patient developing DRESS syndrome.
• Review of clinical presentation, laboratory findings, and drug history.
• Literature review on DRESS syndrome and biologic disease-modifying antirheumatic drugs (bioDMARDs).

Main Results:

• The patient presented with characteristic DRESS symptoms including skin rash, fever, and eosinophilia.
• Certolizumab was identified as the likely causative agent.
• The case highlights the potential for bioDMARDs to trigger DRESS.

Conclusions:

• DRESS syndrome is an under-recognized condition requiring prompt diagnosis and management.
• Clinicians must consider DRESS in patients with unexplained systemic symptoms and characteristic laboratory findings, especially after drug exposure.
• Early recognition of DRESS is crucial, particularly in emergency settings, to initiate appropriate treatment and improve patient outcomes.