Seventeen-year-old sexually active male with rash

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a fairly rare but potentially life-threatening adverse drug reaction characterized by rash, fever, lymphadenopathy, hematologic abnormalities, and multiorgan involvement. Pathogenesis of the disease is not fully understood, but proposed mechanisms include drug metabolism defects, human herpesvirus reactivation, and genetic predisposition. Diagnosis and treatment can be difficult or even delayed, as there are no globally accepted diagnostic criteria and those afflicted have nonspecific clinical findings. There are several drugs well known to produce DRESS syndrome, although Bactrim is not normally thought of as a causative agent. We present the case of a 17-year-old male with high-risk sexual behavior who presented to the pediatric emergency department (ED) with rash and fever, first thought to have symptoms related to sexual history, but was instead diagnosed with DRESS syndrome due to sulfamethoxazole ingestion. This is the only case in the ED literature that describes sulfamethoxazole-induced DRESS syndrome.