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Cyclosporine as an alternative immunosuppressant for steroid-resistant drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome
  1. Katrina Tan and
  2. Adam Testro
  1. Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
  1. Correspondence to Dr Katrina Tan; katrina.tan{at}


Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a multiorgan reaction associated with a broad range of commonly used medications. Most cases of DRESS syndrome resolve with cessation of the inciting agent; however, use of systemic immunosuppression, most commonly with oral corticosteroids, is also recommended in cases with visceral organ involvement.

We report a case of steroid-resistant relapsing–remitting DRESS syndrome secondary to sulfasalazine. Our patient experienced significant flare of symptoms of DRESS syndrome with multiple attempts to wean prednisolone. Initiation of cyclosporine as an alternative immunosuppressive agent to long-term corticosteroids has resulted in a 6-month remission in both dermatological and hepatic sequelae of DRESS syndrome.

  • Hepatitis other
  • Dermatology

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  • Contributors Both authors contributed to the care of the patient and conceptualised the case report. KT wrote the first draft of the case report, including the introduction, background, presentation, investigations, treatment, outcomes and discussion. AT further contributed to the investigations, treatment, outcomes and discussion. Both KT and AT were involved in editing of the case report. KT made subsequent edits and changes to the final report. Both authors approved the final edition of the case report for submission for publication. Consent was discussed with the patient by both KT and AT. Written consent from the patient was obtained by AT.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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