PMC9681788_01
Evolution of the maculopapular rash alongside treatment timeline and laboratory investigations. Intravenous immunoglobulin (IVIG; 2 g/kg/dose) and anakinra (3.7 mg/kg/dose) were both given once. CRP: C-reactive protein, AST: aspartate aminotransferase.
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F1
On physical examination, she had a non-toxic appearance, with a diffuse non-desquamating maculopapular rash on her trunk and back with no involvement of the extremities (Figure 1). She was persistently febrile, and repeated laboratory investigations became concerning for a hemophagocytic disorder, as suggested by the presence of pancytopenia, systemic hyperinflammation with paradoxical decreased erythrocyte sedimentation rate (ESR), hyperferritinemia, transaminitis, and persistent coagulopathy despite three doses of vitamin K (Figure 1). One day after starting the taper, there was a recurrence of a diffuse morbilliform rash and worsening inflammatory markers with marked eosinophilia (Figure 1), which was also consistent with DRESS.