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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, potentially life-threatening, delayed-onset drug reaction characterized by skin eruption, fever, hematologic abnormalities (eosinophilia, atypical lymphocytes), lymphadenopathy, and internal organ involvement. Although initially reported with antiepileptic medications, the syndrome has also been reported with other medications. It is associated with a highly variable clinical presentation, with patients exhibiting a wide array of symptoms. As a result, there is a lack of standardization of both the diagnostic criteria and the nomenclature. DRESS is diagnosed on the basis of clinical presentation as described above. Diagnostic criteria of DRESS -- Cases that report: Onset of symptoms within three months of starting therapy with a drug, AND Evidence of involvement of the skin and/or an extracutaneous organ system, AND At least two of the following: Fever; Eosinophilia (and/or atypical lymphocytes); Lymphadenopathy. Cases are excluded that: Did not report a temporal relationship between suspect drug and reaction; note: this may include cases in which the multiple signs & symptoms associated with DRESS did not occur within one month of each other (e.g. skin eruption followed by lymphadenopathy and fever 6 months later); Did not meet the inclusion criteria above; Reported a condition listed in the differential diagnosis section, or cases that described another more likely diagnosis; Are categorized as \'toxic drug-induced exanthema.\' These include cases in which patients have an exanthem and fever, but other manifestations have not been detected because laboratory tests were either not performed or could not be done.
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