Psychotropic drug-related eosinophilia with systemic symptoms after acute caffeine ingestion.

Pediatrics. 2011 Jan;127(1):e235-8. Epub 2010 Dec 6.

Mahapatra S, Belgrad JL, Adeoye MA.

Department of Pediatrics, Lucile Packard Children’s Hospital, 725 Welch Rd, Palo Alto, CA 94304, USA.


Drug-related eosinophilia with systemic symptoms (DRESS) is a potentially life-threatening, multiorgan condition that can result from drug treatment. Antiepileptic medications have provided the best-studied link of any class of medications.

Here, we report the case of a 16-year-old boy with long-standing bipolar disorder who was chronically treated with aripiprazole and fluoxetine and developed DRESS syndrome after ingestion of high doses of caffeine.

His classic presentation with fever, morbilliform rash, lymphadenopathy, and visceral involvement, including leukocytosis, eosinophilia, and hepatitis, was consistent with this diagnosis.

Furthermore, the patient’s symptoms dramatically improved after corticosteroid therapy and discontinuation of all psychotropic medications. We propose that the development of DRESS syndrome is a net result of inconsistent medication adherence coupled with the ingestion of near-toxic doses of caffeine, which can lead to rhabdomyolysis and, through renal impairment, lead to the accumulation of toxic oxidative metabolites of either or both psychotropic medications.

We also present one of the few reported cases of caffeine-induced rhabdomyolysis and propose its role in the development of DRESS in this patient.

PMID: 21135003 [PubMed – indexed for MEDLINE]


  1. So glad I read this. During my psychosis I was definitely consuming a lot of caffeine, though I knew of some of the effects a lot of caffeine can have I wasn’t aware it could lead to psychotic symptoms. Even though there was more at play in my psychosis than just caffeine, it’s now pretty clear I was consuming enough to at least exacerbate things.
    Another reason to be fobbed off with the doctors I encountered at the time though, not once was I asked about if and how much I drank coffee. And when I had a 2 week stay in a mental ward, what drinks were on offer, tea and coffee! They may have been decaffeinated to be fair, but I’m not 100% on that.

    1. Thanks for sharing your experience.

      It’s very unfortunate so many contributing factors are ignored. Even dehydration can cause psychosis and hydration can help alleviate symptoms of psychosis.

      Take care,

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