Background: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a critical drug-induced hypersensitivity, often associated with antiepileptic drugs.

Case Report: A 21-year-old male with epilepsy developed DRESS syndrome after 8 weeks of phenytoin treatment. Symptoms included fever, widespread erythematous rashes, lymphadenopathy, and gastrointestinal discomfort. Laboratory findings showed leukocytosis, eosinophilia, and elevated liver enzymes, with high serum phenytoin levels. The Regi SCAR score was 7, confirming the diagnosis. Management involved discontinuing phenytoin, starting alternative antiepileptics, and administering corticosteroids and immunosuppressants, leading to patient improvement.

Discussion: This case emphasizes the necessity of early recognition and management of DRESS syndrome in patients on antiepileptic medication. It highlights the importance of the RegiSCAR criteria for diagnosis and the need for vigilant drug level monitoring. The variable presentation of DRESS syndrome, often leading to misdiagnosis, is also discussed.

Conclusion: DRESS syndrome is a life-threatening condition requiring prompt diagnosis and treatment. Awareness among clinicians is essential for early intervention and improved patient outcomes