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Sulfasalazine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) with concomitant acute chikungunya virus infection: possible role of new viral trigger
  1. Abheek Sil1,
  2. Moni Sankar Bhattacharjee2,
  3. Atanu Chandra2 and
  4. Jayasri Das Pramanik1
  1. 1Dermatology, Venereology, Leprosy, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
  2. 2Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
  1. Correspondence to Dr Atanu Chandra; chandraatanu123{at}


Drug reaction with eosinophilia and systemic symptoms (DRESS) is designated as a potentially lethal adverse drug effect with characteristic signs and symptoms such as skin rash, fever, leucocytosis with eosinophilia or atypical lymphocytes, lymphadenopathy and liver or renal dysfunction. In addition to most commonly implicated drug category (aromatic anticonvulsants), lamotrigine, sulfonamides, dapsone and abacavir may also induce this syndrome. We describe here a case a sulfasalazine-induced DRESS with coexisting chikungunya fever. The shared presentation of fever with rash in both conditions made it a challenging diagnosis. Sulfasalazine hypersensitivity manifesting as DRESS has rarely been reported. Furthermore, we document chikungunya virus (CV) as a possible triggering agent for DRESS. To the best of our knowledge, CV as a viral aetiology in DRESS has not been reported previously in the literature.

  • dermatology
  • drugs and medicines
  • tropical medicine (infectious disease)
  • unwanted effects / adverse reactions

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  • Contributors AS and AC prepared the manuscript with adequate planning and execution; they also collected data regarding the patient. AC and MSB were the direct care givers to the patient, who managed the case actively and collected relevant data on investigations with equal contributorship. AC helped in detailed supervision, final output and the review of literature regarding the manuscript. JDP supervised the entire management of the patient and has actively contributed in editing the manuscript. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.