**Introduction** Drug reaction with eosinophilia and systemic symptoms (DRESS), a rare yet potentially fatal drug reaction, typically presents with an extensive maculopapular erythematous rash 2-4 weeks after exposure to the causative agent. Systemic symptoms involve fever and hematologic irregularities, with eosinophilia, transaminitis, and leukocytosis being most common. Its mortality rate is about 10%, highlighting the critical need for early recognition and adequate treatment. We present a severe case of DRESS requiring high dose IV steroids with an atypical mild eczematous rash presentation. **Case Description** A 17-year-old African American male presented to the ED with one-month history of diffuse and pruritic rash, myalgias, and weight loss, along with 2-week history of intermittent fevers, increased somnolence, and facial swelling. Symptoms had not improved despite prior treatments with diphenhydramine and prednisone, followed by amoxicillin and cephalexin for presumed infections at urgent care. Of note, the rash markedly worsened after cephalexin use. On presentation, he was febrile to 102.2 F and tachycardic at 141. Physical exam revealed dry, eczematous skin on the trunk, back, bilateral arms, and bilateral legs. Ulcerated lesions measuring 1mm in diameters with a pink base were also noted on upper and lower back with accompanying abdominal striae. No marked skin sloughing or oral ulcers were observed. Lab work revealed leukocytosis, eosinophilia, normocytic anemia, and transaminitis in addition to an elevated CRP (15.8) and ferritin (> 13,000). Clindamycin was initiated for concern of super-imposed bacterial infection, and Allergy/Immunology was consulted. Peripheral smear and parasitic testing were negative. Repeat labs the following day showed marked increase in LFTs and eosinophilia, most consistent with DRESS Syndrome. High dose IV methylprednisolone 1mg/kg twice daily was initiated along with hydroxyzine and cetirizine for pruritis. Repeat labs prior to discharge showed marked reduction in LFTs, eosinophils, and ferritin and resolution of symptoms. The patient was then discharged with a 4-week corticosteroid taper with outpatient follow up in allergy clinic. **Discussion/Conclusion** Rapid recognition of DRESS and discontinuation of the causative drug, coupled with timely initiation of treatment, is imperative for clinicians to reduce patient mortality and morbidity. In our case, the initial rash likely had a different etiology, but the exposure to cephalexin or amoxicillin is what worsened his clinical status and caused DRESS. Fortunately, he had already been off of antibiotics for >1 week at presentation. Clinicians should be vigilant regarding high-risk medications and recognize atypical rash presentations to ensure early and accurate diagnosis of DRESS.