Anti-tuberculous drug-induced DRESS syndrome in pregnancy with hepatitis E and autoimmune overlap: A case report.

Authors

Muhammad Tanveer Alam, Syed Muhammad Kashif, Muhammad Luqman, Sandesh Raja, Afeera Bashir, Azzam Ali, Hari Lal, Aayush Chaulagain

Published in

Medicine. Volume 105. Issue 29. Pages e49747. Jul 17, 2026.

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening hypersensitivity reaction. Its occurrence during pregnancy, especially secondary to anti-tuberculous therapy (ATT), is exceedingly uncommon and presents major diagnostic and therapeutic challenges.
A 23-year-old pregnant woman (14 weeks gestation) presented with prolonged fever, jaundice, rash with desquamation, and respiratory symptoms while on first-line ATT for pulmonary tuberculosis.
Laboratory evaluation revealed severe eosinophilia, deranged liver function, hepatitis E virus co-infection, and autoimmune overlap (systemic lupus erythematosus with antiphospholipid antibody positivity). Based on clinical features and a Registry of Severe Cutaneous Adverse Reactions score of 6, a definite diagnosis of DRESS syndrome was established.
ATT was discontinued, and she was treated with systemic corticosteroids, antihistamines, and topical therapy. Sequential drug challenges confirmed hypersensitivity to all 4 first-line agents, necessitating initiation of bedaquiline, clofazimine, and delamanid.
The patient showed favorable clinical recovery with improvement in systemic manifestations and stabilization of pregnancy. She was discharged on modified ATT with multidisciplinary follow-up.
This case highlights the complexity of diagnosing and managing DRESS in pregnancy, particularly in tuberculosis-endemic regions. Coexisting viral hepatitis and autoimmune disorders may mimic or exacerbate the syndrome, underlining the importance of high clinical suspicion, timely drug withdrawal, and individualized therapy.

PMID:
42469976
Bibliographic data and abstract were imported from PubMed on 18 Jul 2026.

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