unDRESSed

Boards and textbooks will disagree,
but diagnosing DRESS isn’t easy,
especially given its long latency,
2 to 8 weeks approximately.

Like dress shopping at the mall,
this rash is not one-size-fits-all,
trying it on never goes out of style
so, I’ll make your time worthwhile.

DRESS slips off the tongue,
that’s why it hasn’t been undone.
Like most things in the medical field,
it describes an ideal, not what’s real.

This infamous “rash” or “reaction”
(take your pick, a point of contention)
is more than its nomenclature implies,
no model’s perfect, as hard as it tries.

“Eosinophilia” is a fading fad,
its chance presence is too bad,
because without the vowel “E,”
“DRSS” can’t be pronounced easily.

Eosinophils are the status quo
and steal the hematological show
from atypical lymphocytosis,
(like in mononucleosis).

And “systemic symptoms” are true,
but I must warn you there’s a queue,
nephritis and hepatitis to name a few,
all part of an inflammatory milieu.

Allopurinol is a common culprit,
anti-epileptics and antibiotics, too,
but offenders can be hard to outwit,
and in some cases, mystery ensues.

HHV6 reactivation might be a clue,
and though it hits hard like the flu,
at best we’re still rather hand-wavy
when it comes to pathophysiology.

With a delicate name like DRESS
many truths are hard to impress,
like its diffuse lymphadenopathy,
facial edema or its 10% mortality.

I know you think I’m insane,
because a rash by any other name
is still a rash all the same,
so why this diva disdain?

As clever as DRESS may be
to classify a hypersensitivity,
it simplifies what’s complex,
limiting diagnostic success.

We might be stuck with DRESS,
it’s kind of catchy I must confess,
but at least you know it’s a mess,
so with that, I’ll give it a rest.

 

–last updated on 6/25/18–

 

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