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Commentary Open Access

When Infection Mimics Hypersensitivity: Piperacillin-tazobactam-induced Dress Syndrome & Impact of Chronic Kidney Disease

  • 1Shahida Islam Medical and Dental College, Lodhran, Pakistan
  • 2Faculty of Medicine, Luxor University, Egypt
+ Affiliations - Affiliations

Corresponding Author

Sampana Fatima, sampanasami@gmail.com

Received Date: May 06, 2025

Accepted Date: June 20, 2025

Abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome represents a potentially life-threatening adverse drug reaction characterized by rash, fever, multi-organ involvement, and lymphadenopathy. This paper examines a recent case of piperacillin-tazobactam-induced DRESS syndrome in a patient with chronic kidney disease, highlighting diagnostic challenges and therapeutic approaches. We discuss four areas: antibiotics as unexpected DRESS initiators, atypical presentations with concealed cutaneous eruption, the role of steroid therapy, and the role of Herpes virus reactivation in the pathogenesis of DRESS. 
This case illustrates how DRESS can disguise itself as sepsis in complex patients and lead to diagnostic delay, and raises the hypothesis that chronic kidney disease predisposes to DRESS via drug metabolism alterations or immune dysregulation. This review emphasizes the utility of close monitoring, early recognition, and prompt management in optimizing the outcome of this devastating cutaneous adverse reaction and points out areas of future research, notably regarding the correlation between renal impairment and predisposition to DRESS.

Keywords

DRESS, Hypersensitivity, Piperacillin, Tazobactam, Chronic kidney disease

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