A case of fenofibrate-induced drug reaction with eosinophilia and systemic symptoms accompanied by hemophagocytic lymphohistiocytosis

초록

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe type IV hypersensitivity reaction that typically presents with fever, skin rash, peripheral eosinophilia, and multi-organ involvement, most commonly affecting the liver and kidneys. Early recognition is essential for promptly initiating appropriate corticosteroid treatment. We report a case of fenofibrateinduced DRESS syndrome, an uncommon culprit agent in severe cutaneous adverse reactions. The patient presented with classic manifestations including fever, diffuse erythematous rashes, and significant laboratory abnormalities, fulfilling the RegiSCAR (Registry of Severe Cutaneous Adverse Reactions) criteria for DRESS. During corticosteroid treatment, the clinical course was complicated by the development of pancytopenia. Subsequent bone marrow examination confirmed the diagnosis of hemophagocytic lymphohistiocytosis (HLH). The patient was successfully managed with high-dose systemic corticosteroids, granulocyte-colony stimulating factor, and transfusion support, followed by gradual hematologic and clinical improvement. This case suggests the need for careful monitoring of hematological complications in DRESS syndrome, as well as the evaluation of ferritin, triglycerides, and fibrinogen levels to screen for concurrent HLH. (Allergy Asthma RespirDis2026;14:131-136)

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