Drug Reaction with Eosinophilia and Systemic Symptoms Secondary to Ethambutol

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a T cell mediated, drug-specific immune response associated with end-organ damage. We present the case of a 65 year old woman presenting with a confluent rash, fever, and abdominal pain. Two months prior, she noted a finger lesion which progressed to cellulitis, requiring two debridements with culture growing Mycobacterium marinum. In this time, she was treated with several known triggers for DRESS. The most likely culprit drug was ethambutol and this is the only described case in M. Marinum. This report highlights the challenges of diagnosing and managing DRESS in a patient with concurrent M. marinum cellulitis and multiple high-risk antibiotic exposures.