目的： 藥物疹合併嗜伊紅血症及全身症狀 (DRESS) 為一種可能侵犯內臟的延遲性藥物過敏反應。在糖質類固醇治療突然中斷時，此過敏反應的再發並不少見。此文章描述一位發生DRESS 的病人，在以糖質類固醇治療時由於降低劑量過快而造成病情惡化。
案例說明： 一位患有第五期慢性腎病的50 歲男性服用allopurinol 約2 個月後，因發燒、呼吸困難、臉部浮腫、全身皮疹被送到急診。病人後來被診斷為allopurinol 導致之DRESS，並開始全身性糖質類固醇治療。我們每日給予病人120 mg 注射的methylprednisolone，並逐漸減量轉為口服prednisolone，病人的臨床症狀與實驗室檢驗都有明顯的進步。然而，病人的症狀卻在某次降低糖質類固醇劑量時復發了，因此我們恢之前的劑量，並減緩為每4 ~ 5 日減量一次。病人的皮疹與臉腫在之後已改善。
結論： Allopurinol 導致之DRESS 為一特別且可能致死的皮膚不良反應。臨床工作者應緩慢地降低糖質類固醇治療的計量並密切監測病人，注意復發的情況出現
。

Objective: DRESS (drug reaction with eosinophilia and systemic symptoms) is a delayed-type hypersensitivity reaction with involvement of internal organs. It is not uncommon for the reaction to flare up due to abrupt withdrawal of corticosteroid therapy. We report a patient who developed DRESS associated with acute flare up during tapering of corticosteroid.

Case Summary: A 50-year-old man with stage V CKD was brought to our emergency department with fever,dyspnea, facial swelling, and generalized skin rash after taking llopurinol for 2 months. The diagnosis of allopurinol induced DRESS was made and the patient was started on systemic corticosteroids. Intravenous methylprednisolone 120 mg/day was given, follow with slowly tapering of dosage to oral prednisolone. However, symptoms relapsed during corticosteroid tapering. We resumed the previous dose and tapered the dose every 4 ~ 5 days. Thereafter,patient’s skin rash and facial edema resolved.
Conclusion: Allopurinol induced DRESS is a distinct and potentially fatal cutaneous adverse reaction.Clinicians should gradually taper corticosteroid therapy and closely monitor patient for the emergence of possible relapse.