Register Your Case of DRESS Syndrome

DRESS Syndrome is a potentially life-threatening, drug-induced disease that is often not diagnosed or reported properly. It is estimated to occur in 1 in 1,000 to 1 in 10,000 drug exposures. Currently, there are very few large databases of DRESS cases. By registering your case here, you can help ensure that your case is counted and provide us with a better understanding of drugs that cause DRESS and the complications that patients experience.

The DRESS Syndrome Foundation collaborates with medical researchers who are working to identify the genetic factors that predispose a person to DRESS and the associated long-term complications. If you give your permission, we will contact you if we know of an active study that is relevant to your case of DRESS.

We will never share any personally identifiable information you provide with researchers (or anyone else) without your explicit permission. Your response to this survey will be kept confidential to the best of our abilities.

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* 1. Patient's Name:

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* 2. In what state do you live?

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* 3. In what country do you live?

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* 4. At what email address would you like to be contacted?

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* 5. What is your gender?

Female

Male

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* 6. What is your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 7. Please describe your race/ethnicity.

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* 8. Did patient survive?

Yes

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* 9. Were you diagnosed by a physician with DRESS Syndrome?

Yes

No, but a physician or other suspected DRESS Syndrome.

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* 10. In what month and year did you first become ill with DRESS Syndrome?

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* 11. Were you hospitalized?

Yes

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* 12. What drug(s) is believed to have induced your DRESS Syndrome?

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* 13. Were you tested for HHV-6 (human herpes virus 6) viral reactivation?

Yes

Unsure

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* 14. Was your HHV-6 test positive for reactivation?

Yes

Unsure

N/A

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* 15. What treatments have/did you receive during your acute stage of DRESS?

Systemic Steroids (orally or by IV)

Topical steroids (creams or ointments)

Cyclosporine

Intravenous Immunoglobulin Therapy (IVIG)

Antivirals

No treatment other than stopping the offending medication

Other (please specify)

None of the above

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* 16. Did you experience a relapse or recurrance of symptoms either during or after your treatment for DRESS?

Yes, I experienced a relapse of symptoms while tapering steroids

Yes, I experienced a recurrence of symptoms when exposed to another drug

No, I haven't experienced a relapse or recurrence of symptoms

Other (please specify)

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* 17. Are you still being treated for your symptoms with steroids or other medications? Please specify.

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* 18. Do you have any short or long term complications from DRESS Syndrome such as thyroiditis, auto-immune disease, diabetes, Graves' disease or other? Please specify.

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* 19. Have you experienced any of these emotional and psychological conditions due to having DRESS Syndrome?

Anxiety

Depression

Post Traumatic Stress Disorder (PTSD)

Fear of taking other medications

Fear of hospitals and/or medical providers

Other (please specify)

None of the above

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* 20. Would you be interested in participating in research studies on DRESS Syndrome?

Yes

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* 21. Do you give permission for the DRESS Syndrome Foundation to contact you with follow-up communications regarding your individual case, medical studies, and updates about the Foundation's work?

Yes, I give permission to receive communications from the DRESS Syndrome Foundation

No, I prefer NOT to receive any communications from the DRESS Syndrome Foundation