Drug reaction with eosinophilia and systemic symptoms syndrome caused by an everolimus-eluting stent

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug reaction, mainly caused by anticonvulsants, allopurinol, antivirals, and sulfasalazine. A 48-year-old woman presented with generalized erythema, edema involving mainly the face, and mild itching, associated with fever, enlarged lymph nodes, hypereosinophilia and cytolytic hepatitis. The rash occurred 8 days after the placement of an everolimus eluting stent and the introduction of polytherapy for a single vessel coronary artery disease. Despite drug interruption and treatment with prednisone, the rash resolved only four months later, with normalization of laboratory tests within the following 30 days. All drugs previously discontinued were progressively reintroduced, without relapse of rash. A patch test with everolimus 1% in petrolatum and a prick test with everolimus 0.5% in normal saline were negative. According to the RegiSCARs scoring system, a diagnosis of definite DRESS was made. Some localized or systemic hypersensitivity reactions to DES, but not DRESS syndrome, have been reported. Skin side effects caused by everolimus have been rarely described. In our case, the short latency period and progressive reduction of symptoms only since the fourth month are unusual. The first could be explained by the direct and continuous drug release into the bloodstream, while the long term of this disease is compatible with the timing of everolimus release, which expires within 120 days after implantation.