This weeks case highlights the challenges of ED management of rashes. We discussed the true dermatologic emergencies and their typical presenting symptoms. We also discussed the differences between DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) vs. DILI (drug-induced liver injury).

The patient was admitted for observation and further evaluation for concern of a drug-induced hypersensitivity reaction with concern for evolving DRESS syndrome given systemic symptoms vs Drug induced liver injury due to persistent fever, diffuse rash, and transaminitis following recent TMP-SMX exposure. With eosinophil level being normal the primary diagnosis was drug induced liver injury (DILI) due to Bactrim. 

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