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

Benedetta Marigliano; Federico Rosa; Mattia Internullo; Luigi Scuro; Andrea Tavanti; Lucia Rita Del Vecchio; Francesco Paolo Romagno; Maria Barbara Schito; Federica Pace; Giovanni Maria Colombo; Emanuele Guglielmelli

doi:10.12890/2022_003451

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

Eur J Case Rep Intern Med. 2022 Jul 14;9(7):003451. doi: 10.12890/2022_003451. eCollection 2022.

Affiliations

¹ UOC Pronto Soccorso e Medicina d'Urgenza, Azienda Ospedaliera San Camillo - Forlanini, Rome, Italy.
² UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

Abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is characterised by skin rash together with visceral organ involvement, lymphadenopathy, eosinophilia and atypical lymphocytosis. The syndrome is clinically heterogeneous, making diagnosis challenging. It has an annual incidence of 2 per 100,000 population and a mortality rate of 2-10%. We describe the first case of DRESS induced by certolizumab, a biologic disease-modifying antirheumatic drug (bioDMARD).

Learning points: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is an uncommon and under-reported syndrome.Its recognition is critical for treatment, especially in the emergency setting where most patients first present.In the case of unexplained fever, lymphadenopathy, cutaneous rash and characteristic laboratory findings (e.g., eosinophilia), after infectious causes have been ruled out, clinicians should always keep DRESS in mind and consider possible recent intake of a triggering drug.

Keywords: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS); certolizumab; eosinophilia; lymphadenopathy; rheumatoid arthritis.