Kidney Week

Abstract: SA-PO0381

A Unique Case of KDIGO Stage 3 AKI Caused by Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)-Drug Reaction with Eosinophilia and Systemic Symptoms Overlap Syndrome

Session Information

• AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Doshi, Anusha, MedStar Georgetown University Hospital, Washington, District of Columbia, United States

Anusha Doshi, MD

• Annadanam, Surekha Uma, MedStar Georgetown University Hospital, Washington, District of Columbia, United States

Surekha Uma Annadanam, MD

Introduction

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe cutaneous adverse reaction characterized by rash, fever, and internal organ involvement¹. 30-42% of patients with DRESS develop acute kidney injury (AKI) ^2,3 and of these, 30% require renal replacement therapy^1,4. Mortality in cases of renal involvement is higher than that with DRESS overall⁴. However, with appropriate treatment, many of these patients exhibit renal recovery and dialysis-independence⁴.

Case Description

A 57-year-old male with recent antibiotic exposure (vancomycin and meropenem) presented with a diffuse morbilliform rash with scattered bullae. His labwork showed eosinophilia (21%) and skin biopsy revealed detached epidermis with full thickness necrosis and scattered eosinophils. He was diagnosed with an overlap syndrome of Stevens Johnson Syndrome/Toxic Epidermal Necrolysis with DRESS given the degree of peripheral eosinophilia and morbilliform appearance of the rash. He initially improved with intravenous fluids, systemic cyclosporine, and topical triamcinolone and silver sulfadiazine but a few days later he rapidly declined, developing new onset fevers, sinus tachycardia, waxing and waning mental status, hypoxia, and oliguria. His labwork showed worsening leukocytosis, lactic acidosis, AKI with hyperkalemia (serum creatinine 1.6 to 4.8 ; potassium 6.5), and transaminitis. His infectious workup was unrevealing, and his multiorgan dysfunction was attributed to DRESS Syndrome. He was immediately intubated for airway support and started on stress dose steroids. He required initiation of intermittent hemodialysis (iHD) for stage 3 AKI. After several days of supportive care and systemic steroids, he exhibited renal recovery and was able to wean off iHD.

Discussion

SJS/TEN and DRESS are severe cutaneous reactions characterized by T-cell mediated type IV hypersensitivity, most commonly caused by antibiotics. These conditions commonly present independently, but overlap syndromes have been increasingly recognized in the literature which exhibit features of both disorders. DRESS Syndrome is particularly associated with multiorgan dysfunction, including AKI. Proposed mechanisms include acute interstitial nephritis, hemodynamic instability, and systemic inflammatory injury. Management involves prompt discontinuation of the offending agents and initiation of supportive care, with use of systemic corticosteroids in severe cases.