Abstract
One of the most severe and life-threatening skin manifestations of drug reaction is known as Drug Reaction with Eosinophilia and Systemic Symptom (DRESS), characterized by skin manifestations (rash), fever, eosinophilia and involvement of systemic organs. The diagnosis of DRESS is a clinical challenge with high mortality. The most common reported causative agents are anti-seizure drugs and allopurinol. In an effort to make a more accurate definition of the DRESS syndrome, there are some scoring system has been introduced recently.
We report a 50 years old, male with DRESS who was complained of skin rash and multiple bullae on extremities with a history of fever. The Patient has a history of allopurinol consumption. The laboratory finding was hypereosinophilia. In this case, based on the RegiSCAR scoring system was concluded as probable DRESS. The patient was treated with oral corticosteroid and avoidance of allopurinol. The patient was reported improvement in the first 2 weeks, however, the patient then has the complication of gastrointestinal bleeding.
Diagnosis of DRESS is difficult however some scoring system would help guide the diagnosis. The management of DRESS mainly supportive care and avoidance of causative agent. Corticosteroid is one of the primary medical treatment for DRESS. A drug allergy should always be suspected in a patient presenting with a cutaneous skin rash with systemic symptom and eosinophilia with a history of the new administration of medication. Avoiding the culprit agent is one of the successful strategies for most cases. Corticosteroid is one of the primary treatment, however still controversial regarding the side effect of prolonged use of this medication.

Key words: DRESS syndrome, drug reaction, hypereosinophilia, allopurinol, corticosteroid