A Rare Presentation of an Adverse Reaction to Minocycline

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, severe adverse drug reaction, usually associated with antibiotics and anticonvulsants. A 17-year-old girl with maculopapular rash, arthralgia, fever, and facial edema (plus eosinophilia and hepatitis) repeatedly goes to the emergency department, initially omitting having started minocycline three weeks before symptom onset. Diagnosis of serum-like sickness was first established, minocycline was suspended, and a short course of corticosteroid therapy was started. However, the fast taper of corticotherapy resulted in the reappearance of previous symptoms, as well as renal dysfunction and respiratory distress. Chest CT showed interstitial pneumonitis. With these findings, the final diagnosis of DRESS was made, and the re-adjustment of corticoid therapy resulted in symptom improvement. This case highlights the diagnostic and treatment challenges of DRESS and the importance of an all-around approach to the patient.