Colonic involvement in DRESS syndrome: A review of rare but severe manifestations

Abstract

Background: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe cutaneous adverse reaction with multi organ involvement. While hepatic, renal, and pulmonary complications are well-documented, gastrointestinal involvement, particularly colitis, remains rare. Case Presentation: We report the case of a 37-year-old male who developed DRESS syndrome secondary to carbamazepine therapy, presenting with diffuse cutaneous eruption, fever, and gastrointestinal symptoms, including severe colitis. The diagnosis was confirmed through clinical evaluation, histopathology, and the RegiSCAR scoring system. The patient responded well to corticosteroid therapy, with full resolution of the symptoms at the six-month follow-up. Discussion: A literature review highlighted colitis as an uncommon but serious complication of DRESS syndrome, particularly with antiepileptic drugs. Early recognition and withdrawal of the offending drug are critical for preventing severe outcomes. Clinicians should consider gastrointestinal involvement in DRESS, particularly when abdominal symptoms are accompanied by fever and rash. Conclusion: Colitis is a rare but potentially severe manifestation of DRESS syndrome. Timely diagnosis, drug discontinuation, and appropriate management can significantly improve patient outcome and prevent complications.