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DEAR DR. ROACH: Could you explain what happened to me with a condition called DRESS syndrome? I had back-to-back urinary tract infections (UTIs) that were about six weeks apart. For the first one, I was treated with three days of an antibiotic, and it went away. For the second, I was given another week of the same antibiotic.
My UTI symptoms improved quickly, but after three days on the antibiotic, I developed a rash. I first noticed spots on my legs, but by the next morning, they were on both of my legs and arms with some on my belly and upper back. The following day, I had fever, chills, profound weakness and dizziness.
I went to the emergency room, and my blood pressure dropped to 80/42 mm Hg. I had elevated liver enzymes and an elevated kidney function. Although my total white blood cell count was OK, one type of blood cell count -- eosinophil -- was high. I was treated with fluids and IV antibiotics for sepsis.
All my cultures, including the urine and blood cultures, were subsequently normal. The infectious disease doctor ultimately diagnosed me with DRESS syndrome -- a type of adverse drug reaction to the antibiotic. She stopped all antibiotics. She said that the second infection was likely a holdover from the first one, and my body just reacted badly to the antibiotic.
So, what happened? I was shocked that it affected so many things -- my blood pressure, kidneys, liver, etc. I felt so dreadful. -- D.L.B.
ANSWER: If a person comes in with an infection, low blood pressure, and dizziness, it would be assumed that they have sepsis, and I can’t fault the ER for treating you aggressively with IV antibiotics and fluids. Septic shock is a life-threatening emergency, and it can take only minutes before the process becomes irreversible once a person shows up in the ER.
However, one clue was there from the beginning. The rash started when you got a second dose of the antibiotic and had been there for over a day before the severe symptoms and low blood pressure became present. Your eosinophil count was another clue as to the diagnosis.
A drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, allergic-type reaction. The exact mechanism isn’t known, but up to 75% of people with DRESS develop a reactivation of one of the common herpes viruses, including Epstein-Barr virus, cytomegalovirus, HHV-6, and HHV-7 -- all of which can cause a mononucleosis-type syndrome. This may be due to a temporary decrease in the immune system, which is associated with the severe illness.
Several antibiotics are associated with DRESS, including sulfa drugs, vancomycin, minocycline, and several drugs for tuberculosis. In addition, antiseizure drugs and allopurinol for gout are considered high-risk for DRESS.
Your infectious disease doctor was very sharp to recognize this uncommon condition (1 per 100,000 people per year) and stop the offending antibiotic. The fact that your cultures all came back negative (making an infection unlikely) and that you got better after stopping the antibiotic confirms she was almost certainly right.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
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