RESUMO
Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening, multi-organ adverse drug reaction with an incidence of 1 in 1000 to 1 in 10 000 high-risk drug exposures. Case Presentation: An elderly female presented to the hospital with progressive weakness and a diffuse erythematous macular rash covering most of her body that started 3 days prior. Over the next 3 days, the patient quickly deteriorated, developing disorientation with acute onset left-sided weakness, leukocytosis, thrombocytopenia, eosinophilia, liver and kidney failure, and hypoxia. Clinical and histological changes supported the diagnosis of DRESS syndrome caused by intravenous (IV) ampicillin administered during a prior hospitalization for a urinary tract infection. Systemic corticosteroids were initiated quickly thereafter, but the patient ultimately succumbed to complications caused by DRESS syndrome. Conclusion: There are currently no randomized trials evaluating treatments for DRESS, and evidenced-based guidelines are lacking. Viral reactivation has also been suggested as a possible complication of DRESS syndrome, though the true incidence and association remain unclear. Although we started our patient on high-dose IV corticosteroids early in her course, she still succumbed to complications of DRESS syndrome. Further research into the treatment of DRESS syndrome and its association with viral reactivation is essential.
RESUMO
Purpura fulminans (PF) is a life-threatening emergency involving coagulopathy and widespread skin necrosis. Early treatment, especially surgical management, is imperative as prognosis can be very poor. PF is most commonly associated with severe bacterial illness; however, viral causes are also possible. Currently in the literature, there have only been a handful of PF cases associated with COVID-19. We present two cases of PF in the setting of COVID-19 infection. Both patients had a history of underlying coagulopathies. PF can be a sign of underlying coagulopathy in a COVID-19 patient, who is already at increased risk for thromboembolic events due to the inflammatory nature of COVID itself. Due to how quickly PF can develop into life-threatening necrosis and multiorgan failure, it is imperative that these patients are referred early to a burn center for more advanced care.
