University of Wisconsin–Madison Medical College of Wisconsin

A Rare Case of Acne Medication-Induced Drug Reaction With Eosinophilia and Systemic Symptoms

Benjamin L. Hamel, MD; Sadie F. Mason, MD; Alina G. Burek; Kristen E. Holland, MD

WMJ. 2022;121(3):e53-e56

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Introduction: Acne vulgaris is the most common skin condition in late adolescence and frequently requires systemic treatment with antibiotics or androgen receptor blockers in moderate-to-severe cases.

Case Presentation: We report the case of a 17-year-old adolescent female with new onset fever, headache, and pruritic rash 1 month after she started doxycycline and spironolactone for the treatment of acne vulgaris. Later, she developed eosinophilia and transaminitis. Infectious workup was negative.

Discussion: This presentation was consistent with a definite case of drug reaction and eosinophilia with systemic symptoms (DRESS). DRESS is a severe, systemic hypersensitivity drug reaction that typically occurs 2 to 8 weeks following exposure to the offending medication.

Conclusions: Although doxycycline and spironolactone are uncommon triggers of DRESS, they are common medications used to treat acne, and clinicians should be aware of this potential complication when counseling patients, especially adolescents.

Author Affiliations: Department of Pediatrics, Medical College of Wisconsin (MCW), Milwaukee, Wisconsin (Hamel, Mason, Burek); Children’s Wisconsin, Milwaukee, Wisconsin (Mason, Burek, Holland); Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin (Holland).
Corresponding Author: Benjamin L. Hamel, MD, Children’s Hospital of Wisconsin, Children’s Corporate Center Suite 730, Milwaukee, WI 53226; phone 651.324.1383; email; ORCID ID 0000-0001-8086-3428
Acknowledgements: Parental consent for publication of patient images was obtained in writing.
Funding/Support: None declared.
Conflict of Interest Disclosures: Dr Holland reported serving as a principal investigator on clinical trials for Sanofi, AbbVie, Amgen, Incyte Corp, and Pfizer. Fees for this contracted research were paid to the institution. No other disclosures were reported.
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