Introduction
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare drug hypersensitivity reaction characterized by diffuse skin eruption and systemic symptoms including fever, lymphadenopathy, elevated transaminases, and eosinophilia.1 DRESS syndrome typically develops 2-6 weeks after a viral infection or exposure to inciting medications, most commonly antibiotics, antiepileptics, and allopurinol.1 The clinical presentation of DRESS syndrome is variable and non-specific, and is associated with high morbidity and mortality, therefore a high index of suspicion is necessary. While anticoagulants aren’t typically associated with DRESS syndrome, there are documented cases in the literature involving vitamin K antagonists and oral anticoagulants, as well as two enoxaparin related cases in adult patients.2,3,4 There are no reports of DRESS syndrome in children secondary to anticoagulants. We present a case of a pediatric patient with DRESS syndrome secondary to therapy. As anti-coagulants are increasingly prescribed to pediatric patients, especially in the wake of hyper-inflammatory syndromes caused be COVID19, it is crucial for pediatricians and pediatric hematologists to consider enoxaparin as a potential cause in patients with DRESS syndrome.