ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-PO169

DRESS to Impress: Unusual Case of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) due to Epoetin Alfa

Session Information

Category: Trainee Case Report

  • 202 Anemia and Iron Metabolism: Clinical


  • Santos Roman, Yelixa, Veterans Affairs Caribbean Healthcare system, Coto Laurel, Puerto Rico, United States
  • Cortes, Carlos, Veterans Affairs Caribbean Healthcare system, Coto Laurel, Puerto Rico, United States

DRESS syndrome is a severe life-threatening hypersensitivity reaction to medication or its active metabolites. It manifests with fever, rash & organ involvement, kidneys & liver most commonly. It has a 10% mortality rate. More frequently associated with DRESS are sulfonamides, anti-inflammatory medications & anticonvulsants. There is only one case report of epoetin alfa related DRESS syndrome in the literature, and herein we present the second.

Case Description

92 y/o man with hypertension, A. fib. & CKD IIIa arrived at ED due to generalized pruritic skin eruption since 7 days ago. Physical exam: generalized non-blanching erythematous patches on lower extremities, torso & upper extremities. Few violaceous purpuric patches on extremities, petechias on palms & feet. Labs: WBC: 17.9 x10^3/UL, Plt: 270 10^3/UL, Eosinophils: 895. BUN: 50.7 mg/dL & Cr.: 1.8 mg/dl (base:1.2), ALT: 39, AST: 23 & CRP: 127.3. He was started on epoetin alfa 8 days prior, which was discontinued upon admission. Dermatology biopsied a lesion & recommended methylprednisolone (MP) IV for 2 days. Rash, eosinophils & creatinine improved. MP was discontinued as per derm. recc. but rash, eosinophils & creatinine again worsened. Biopsy: spongiotic dermatitis w/parakeratosis, pustules in stratum corneum, dermal perivascular lymphocytic infiltrate & scanty eosinophils. Allergist recc. restart MP for epoetin alfa related DRESS. See Fig 1 for data on MP, creatinine & eosinophils. He improved & was discharged on a steroid tapering


The European Registry of severe cutaneous adverse reactions is a scoring system to help yield the diagnosis of DRESS, a score of 6 makes it definitive, as presented in this case. Only ~11% of patients with DRESS manifest with renal disease. After literature review, this is only the second case of epoetin alfa associated DRESS. Epoetin alfa is a commonly used drug in patients with CKD & physicians should be aware of this potentially fatal adverse effect.

Changes in eosinophilia and creatinine with methylprednisolone dose