Antibiotic-induced DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) in an infant with Down syndrome

Introduction: Drug Rash with Eosinophilia and Systemic Symptoms syndrome (DRESS) is a rare but serious drug reaction. This syndrome is associated with an immune reaction triggered by the use of certain medications. Rare cases of DRESS have been reported in early infancy or in infants with chromosomal disorders, making their prognosis unknown. Observation: A 20-month-old infant with trisomy 21 was hospitalized for a febrile (39 °C) rash with systemic symptoms. He had been hospitalized twenty days earlier for pneumonia, which was treated with antibiotics (cefotaxime and vancomycin). Physical examination revealed facial edema, a diffuse maculopapular rash involving the entire body and face and cervical lymphadenopathy. Laboratory tests showed leukocytosis with eosinophilia and liver damage (liver transaminases were 20 times the normal level). The diagnosis of DRESS syndrome due to antibiotics was made based on a RegiSCAR score of 7. The infant was treated with IV corticosteroids at a dose of 1 mg/kg/day, along with a 2 g/kg infusion of gammaglobulin. Clinical and laboratory improvement was observed with disappearance of skin lesions and normalization of laboratory values. Discussion: The diagnosis of DRESS syndrome due to antibiotics was made based on a RegiSCAR score of 7. This class of drugs is the leading cause of DRESS syndrome described in children. The evolution of our infant patient with Down syndrome and DRESS syndrome was favorable.