A 30-year-old woman develops DRESS syndrome secondary to allopurinol. She has fever, facial edema, generalized exanthem, hepatitis, and nephritis. Which organ involvement in DRESS is most predictive of a fatal outcome?

• A Myocarditis with cardiac dysfunction ✓
• B Acute interstitial nephritis with renal failure
• C Pneumonitis with respiratory failure
• D Encephalitis with altered sensorium

Explanation

DRESS-associated myocarditis is the most feared complication and carries the highest fatality rate. It can present as asymptomatic troponin elevation or progress rapidly to fulminant heart failure and arrhythmias. Cardiac involvement is often underrecognized and requires urgent echocardiography and troponin monitoring. Allopurinol is the most common drug causing DRESS in India and is strongly associated with renal and cardiac complications. Early recognition with cardiac biomarkers is essential.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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