An 80‐year‐old man presented with 2 days of fever and a widespread, itchy, non‐blanching, erythematous rash involving more than 50% of body surface area over arms, legs, abdomen, back and palms, with sparing of the face and soles of feet (Box 1). He had a history of type 2 diabetes mellitus (treated with sitaglipin 100 mg and metformin 1000 mg modified release daily), hypertension (perindopril arginine 2.5 mg daily), vitamin D deficiency (weekly colecalciferol 125 μg oral) and pernicious anaemia.
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- 1. Kardaun SH, Sidoroff A, Valeyrie‐Allanore L, et al. Variability in the clinical pattern of cutaneous side‐effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol 2007; 156: 609–611.
- 2. O'Hagan DT, Ott GS, De Gregorio E, Seubert A. The mechanism of action of MF59 — an innately attractive adjuvant formulation. Vaccine 2012; 30: 4341–4348.
- 3. Schaffner W, Chen WH, Hopkins RH, Neuzil K. Effective immunization of older adults against seasonal influenza. Am J Med 2018; 131: 865–873.
- 4. Solak B, Dikicier BS, Kara RO, Erdem T. DRESS syndrome potentially induced by allopurinol and triggered by influenza vaccine. BMJ Case Rep 2016; 2016: bcr2016214563.
- 5. Hewitt N, Levinson M, Stephenson G. Drug reaction with eosinophilia and systemic symptoms associated with H1N1 vaccination. Intern Med J 2012; 42: 1365–1366.
- 6. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–245.
- 7. Shiohara T. The role of viral infection in the development of severe drug eruptions. Dermatologica Sinica 2013; 31: 205–210.
- 8. Ramírez E, Medrano‐Casique N, Tong HY, et al. Eosinophilic drug reactions detected by a prospective pharmacovigilance programme in a tertiary hospital. Br J Clin Pharmacol 2017; 83: 400–415.
- 9. Villa M, Black S, Groth N, et al. Safety of MF59‐adjuvanted influenza vaccination in the elderly: results of a comparative study of MF59‐adjuvanted vaccine versus nonadjuvanted influenza vaccine in northern Italy. Am J Epidemiol 2013; 178: 1139–1145.
- 10. Lindert K, Leav B, Heijnen E, et al. Cumulative clinical experience with MF59‐adjuvanted trivalent seasonal influenza vaccine in young children and adults 65 years of age and older. Int J Infect Dis 2019; 85S: S10–S17.
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We acknowledge the input of Jason Trubiano and Nigel Crawford for valuable discussions in the management of this case.
No relevant disclosures.