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Hydroxychloroquine Induced DRESS (Drug Rash with Eosinophilia and Systemic Symptoms Syndrome) Mimicking SARS-COV-2 Illness: A Case Report with Review

Maitri M. Patel, Dhruvkumar M. Patel, M. Patel, J. Gurumukhani, Suyog Y. Patel, Harsh Patel

Coronaviruses, 2020

Abstract

In the current pandemic of COVID-19, hydroxychloroquine (HCQ) is recommended

as an experimental drug for prophylaxis and treatment of the illness. Although it is a safe drug,

it can rarely produce a severe drug reaction ‘drug rash with eosinophilia and systemic symptoms syndrome

(DRESS)’, and to differentiate it from systemic viral infections is challenging.

A 45-year old male nurse working in a COVID-19 ward consumed HCQ weekly for

two weeks for prevention of SARS-COV-2 illness. He presented with fever, pruritic maculopapular

palmar rash, cervical lymphadenopathy for 12 hours and was quarantined as a suspected COVID-19

case. His laboratory tests revealed lymphopenia, eosinophilia, atypical lymphocytes, raised liver enzymes

along with IgM negative, IgG positive rapid antibody test of SARS-COV-2. However, his throat

swabs for SARS-COV-2 by real-time PCR were negative on day 1 and 7. He was finally diagnosed as

definite DRESS based on the RegiSCAR score of six. He responded to levocetirizine 5 mg OD and oral

prednisolone 60 mg daily tapered over 7 days.

DRESS due to HCQ is ‘probable’, ‘of moderate severity’, and ‘not preventable’ adverse

effect mimicking SARS-COV-2 illness.

How strong is the evidence?

Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.

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