Introduction
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome
is a rare drug hypersensitivity reaction characterized by diffuse skin
eruption and systemic symptoms including fever, lymphadenopathy,
elevated transaminases, and eosinophilia.1 DRESS
syndrome typically develops 2-6 weeks after a viral infection or
exposure to inciting medications, most commonly antibiotics,
antiepileptics, and allopurinol.1 The clinical
presentation of DRESS syndrome is variable and non-specific, and is
associated with high morbidity and mortality, therefore a high index of
suspicion is necessary. While anticoagulants aren’t typically associated
with DRESS syndrome, there are documented cases in the literature
involving vitamin K antagonists and oral anticoagulants, as well as two
enoxaparin related cases in adult patients.2,3,4 There
are no reports of DRESS syndrome in children secondary to
anticoagulants. We present a case of a pediatric patient with DRESS
syndrome secondary to therapy. As anti-coagulants are increasingly
prescribed to pediatric patients, especially in the wake of
hyper-inflammatory syndromes caused be COVID19, it is crucial for
pediatricians and pediatric hematologists to consider enoxaparin as a
potential cause in patients with DRESS syndrome.