Allopurinol-induced DRESS complicated by hemophagocytic lymphohistiocytosis

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and severe drug-induced syndrome that has been associated with several drugs, namely allopurinol. Although the prognosis of this syndrome is most often benign, early detection and withdrawal of the causative drug is essential to reduce morbidity, severe organ involvement and mortality. We report a case of a 66-year-old man diagnosed with DRESS syndrome shortly after initiating gout treatment with allopurinol who developed a fatal hemophagocytic lymphohistiocytosis due to Epstein-Barr virus reactivation. DRESS syndrome is a rare and possibly fatal condition triggered by commonly used drugs in every day practice. Awareness of this condition is fundamental for prompt diagnosis, treatment and avoidance of potentially fatal outcomes.