• Amin Daoulah, Awad A R Alqahtani, Sara R Ocheltree, Abdulkarim Alhabib, and Ali R Ocheltree.
• Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center-Jeddah, P.O. Box 40047, Jeddah 21499, Kingdom of Saudi Arabia. amindaoulah@yahoo.com
• Am J Emerg Med. 2012 May 1;30(4):638.e1-3.

AbstractDrug rash, eosinophilia, and systemic symptoms (DRESS) syndrome represents one pattern of the cutaneous involvement in type IV hypersensitivity reaction to drugs. It is a severe, delayed, idiosyncratic reaction presented as rash with fever, lymphadenopathy, and visceral involvement. There are several reported cases of sulfasalazine-induced DRESS syndrome, but myocardial involvement was rare. High index of suspicion is needed in every patient receiving these drugs for prompt diagnosis and early management. We report a case of a 56-year-old woman treated with sulfasalazine for ankylosing spondylitis for 3 weeks, which was discontinued after development of DRESS syndrome. Despite treating her with high dose of steroid and cyclosporine, her symptoms persisted, and ultimately, she developed toxic myocarditis with a misleading presentation of acute ST-elevated myocardial infarction. The diagnosis was made based on postmortem histopathologic finding.

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