Drug reaction with eosinophilia and systemic symptoms (DRESS) manifests with severe drug-induced symptoms that occur 3 to 6 weeks after initiation of therapy. Manifestations include high fever, facial edema, erythroderma, eosinophilia, lymphadenopathy, and elevated liver function tests. Although DRESS may occasionally be severe and life-threatening, prognostic factors have not yet been identified. In this retrospective series of severe cases of DRESS, Eshki et al suggest that some medications, including allopurinol and minocycline, are more likely to produce a more severe form of the disease. They also confirm the role of early human herpesvirus 6 reactivation in the development of severe DRESS syndrome.