A case of progesterone-induced drug reactions presenting with eosinophilia and systemic symptoms
10.4168/aard.2025.13.2.70
- Author:
Chang-June CHOI
1
;
Jae-Hyuk JANG
;
Soyoon SIM
;
Hyun-Seob JEON
;
Youngsoo LEE
;
Hae-Sim PARK
Author Information
1. Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
- Publication Type:CASE REPORT
- From:Allergy, Asthma & Respiratory Disease
2025;13(2):70-74
- CountryRepublic of Korea
- Language:English
-
Abstract:
Progesterone hypersensitivity is mediated by type I, III, and IV hypersensitivity reactions to endogenous or exogenous progesterone, involving autoimmune mechanisms in females of reproductive age. It presents with a range of dermatologic manifestations, most commonly urticaria, angioedema, eczema, and maculopapular rashes. Systemic and severe symptoms, such as generalized erythema multiforme or lesions resembling severe cutaneous adverse reactions, have rarely been reported. We describe a case of a 42-year-old woman who developed drug reaction with eosinophilia and systemic symptoms (DRESS) following exogenous progesterone therapy administered for assisted reproduction. She received high-dose subcutaneous progesterone and vaginal tablets. Despite this being her first procedure, she achieved pregnancy. However, at 8 weeks of gestation and during the third month of progesterone treatment, she developed generalized erythema multiforme, pruritus, and high-grade fever. Her laboratory findings showed increased blood eosinophil counts and inflammatory markers. After oral corticosteroid (OCS) treatment for several weeks, her skin lesions were partially improved. However, after tapering of OCS, her skin lesions were aggravated with increased blood eosinophil counts. Despite daily OCS (prednisolone, 12.5–60 mg/day) treatment after childbirth, her skin symptoms and eosinophilia persisted. Reslizumab treatment was also attempted, but only the eosinophilia resolved. These clinical findings were much improved after Janus kinase (JAK) inhibitor (upadacitinib 15 mg/day) treatment; consequently, OCS was stopped. Here, we report a case of relapsing DRESS triggered by exogenous progesterone, which has been controlled by JAK inhibitor treatment.
