Case Report

Relapse of Sulfasalazine-Induced DRESS Syndrome Following the Administraton of Contrast Media: A Case Report


Sulfasalazine, a non-antibiotic sulfonamide, is associated with severe hypersensitivity reactions, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. We report a case of sulfasalazine-induced DRESS syndrome that relapsed following the administration of visipaque® (iodixanol). Macular rashes, pruritus, and an acute exacerbation of dyspnea were immediately observed after the administration of contrast media. It seems that patients suffering from DRESS syndrome are sensitive to the administration of other new medications with a high possibility of hypersensitive reactions. It can be concluded that iodinated contrast media should be used cautiously in patients with DRESS syndrome.

[1] Waseem D, Latef M, Sof N, Dar I, Khan Q, Abbas F, et al. Dress syndrome: A review and update. Skin Dis Skin Care. 2016; 1(1):8. htps:// Dar/publicaton/298485704_Dress_Syndrome_A_Review_and_Update/ links/56e9abf208ae25ede830b1a0/Dress-Syndrome-A-Reviewand-Update.pdf
[2] Criado PR, Criado RF, Avancini JM, Sant CG. Drug reacton with Eosinophilia and Systemic Symptoms (DRESS)/Drug-induced Hypersensitvity Syndrome (DIHS): A review of current concepts. Anais Brasileiros de Dermatologia. 2012; 87(3):435-49. [DOI:10.1590/S0365-05962012000300013] [PMID]
[3] Choudhary S, McLeod M, Torchia D, Romanelli P. Drug Reacton with Eosinophilia and Systemic Symptoms (DRESS) syndrome. The Journal of Clinical and Aesthetc Dermatology. 2013; 6(6):31-7.
[4] Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: Part II. Management and therapeutcs. J Am Acad Dermatol. 2013; 68(5):709. e1-9; quiz 718-20. [DOI:10.1016/j.jaad.2013.01.032] [PMID]
[5] Kirchhof MG, Wong A, Dutz JP. Cyclosporine treatment of druginduced hypersensitvity syndrome. JAMA Dermatology. 2016; 152(11):1254-7. [DOI:10.1001/jamadermatol.2016.2220] [PMID]
[6] Singh JA, Saag KG, Bridges Jr SL, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthrits. Arthrits Care & Research. 2016; 68(1):1-25. [DOI:10.1002/acr.22783] [PMID]
[7] Cildag S, Senturk T. Sulfasalazine-related hypersensitvity reactons in patents with Rheumatc diseases. Journal of Clinical Rheumatology. 2017; 23(2):77-9. [DOI:10.1097/RHU.0000000000000490] [PMID]
[8] Kardaun SH, Sidoroff A, Valeyrie-Allanore L, Halevy S, Davidovici BB, Mockenhaupt M, et al. Variability in the clinical patern of cutaneous side-effects of drugs with systemic symptoms: Does a DRESS syndrome really exist?. The Britsh Journal of Dermatology. 2007; 156(3):609-11. [DOI:10.1111/j.1365-2133.2006.07704.x]
[9] Roujeau JC, Allanore L, Liss Y, Mockenhaupt M. Severe Cutaneous Adverse Reactons to drugs (SCAR): Defnitons, diagnostc criteria, genetc predispositon. Dermatol Sinica. 2009; 27(4):203-9. [DOI:10.1111/j.1365-2133.2006.07704.x]
[10] Cho YT, Yang CW, Chu CY. Drug Reacton with Eosinophilia and Systemic Symptoms (DRESS): An interplay among drugs, viruses, and immune system. Internatonal Journal of Molecular Sciences. 2017;
18(6):1243. [DOI:10.3390/ijms18061243] [PMID] [PMCID]
[11] Funck-Brentano E, Duong TA, Bouvresse S, Bagot M, Wolkenstein P, Roujeau JC, et al. Therapeutc management of DRESS: A retrospectve Mohebbi N, et al. Relapse of DRESS Syndrome With Contrast Media. CRCP. 2021; 6(3):94-98.
May /June 2021, Volume 6, Issue 398 study of 38 cases. Journal of the American Academy of Dermatology. 2015; 72(2):246-52. [DOI:10.1016/j.jaad.2014.10.032] [PMID]
[12] Shiohara T, Kano Y, Hirahara K, Aoyama Y. Predicton and management of drug reacton with eosinophilia and systemic symptoms (DRESS). Expert Opinion on Drug Metabolism & Toxicology. 2017; 13(7):701-4. [DOI:10.1080/17425255.2017.1297422] [PMID]
[13] Taghvaye Masoumi H, Hadjibabaie M, Zarif-Yeganeh M, Arasteh O. Exacerbaton of allopurinol-induced drug reacton with eosinophilia and systemic symptoms by teicoplanin: A case report. Journal of Clinical Pharmacy and Therapeutcs. 2017; 42(5):642-5. [DOI:10.1111/jcpt.12556] [PMID]
[14] Picard D, Vellar M, Janela B, Roussel A, Joly P, Musete P. Recurrence of drug-induced reactons in DRESS patents. Journal of the European Academy of Dermatology and Venereology. 2015; 29(4):801-4. [DOI:10.1111/jdv.12419] [PMID]
[15] Häussler MD. Safety and patent comfort with iodixanol: A postmarketng surveillance study in 9515 patents undergoing diagnostc CT examinatons. Acta Radiologica. 2010; 51(8):924-33. [DOI:10. 3109/02841851.2010.504739] [PMID]
IssueVol 6 No 3 (2021): May-June QRcode
SectionCase Report(s)
Contrast media Drug reaction with eosinophilia and systemic symptoms Hypersensitivity reactions Sulfasalazine

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Mohebbi N, Taghvaye-Masoumi H, Khosravi-Khezri M, Talaschian M. Relapse of Sulfasalazine-Induced DRESS Syndrome Following the Administraton of Contrast Media: A Case Report. CRCP. 2021;6(3):94-98.