Anand – one of two other UK-trained GPs at my clinic in Canada – was heading back to Britain for a few weeks. “Can you look after Petra while I’m away? I’m not sure what’s going on yet, but she’s one very unhappy lady.”
It was a vote of confidence to be asked to take on a difficult case, but there was also an element of test about it. This was just a fortnight after I’d started; my new colleagues had yet to get the measure of me. If things went well, it would help build working relationships. Conversely, if I handled it badly, they might doubt the wisdom of appointing me.
Petra proved to be a smartly dressed 60-year-old east European émigrée whose thick Slavic accent was undiluted by the decades she’d spent living in British Columbia. She was also, as Anand had said, very unhappy. For two months she’d been tormented by a florid, intensely itchy rash from head to toe, with bulky swelling of the lymph glands in her neck and underarms, and was occasionally feeling feverish, nauseated and unwell. Twice Anand had resorted to high-dose oral steroids to give her some relief.
He’d arranged numerous blood tests. Petra’s liver was inflamed, and the level of eosinophils – a type of white blood cell associated with parasitic infections or allergy – was markedly raised: eosinophilia. The temperatures and gland-swelling suggested an infectious cause, but Anand’s investigations had failed to identify a culprit. I confirmed Petra had not travelled anywhere exotic, and said I would do some book work to try to figure out where to turn next.
Book work no longer involves books: the entire medical literature is searchable online. I ploughed through several papers without enlightenment before stumbling across a footnote that made a passing reference to drug rash with eosinophilia and systemic symptoms (Dress). It’s rare – I’d never seen it – but as I looked further into it, I became sure it would explain Petra’s blood results and her physical symptoms.
Dress was formally defined in 1996. It is typically provoked by anti-epileptic medications, as well as some antibiotics and a tablet given to prevent gout. While most drug allergies come on quickly, Dress has a delayed onset of up to two months. Even once the offending pharmaceutical has been discontinued, the condition can take many weeks to settle.
The problem was Petra wasn’t being prescribed any such medication. I phoned her to double-check. That revealed a possible culprit: a month before becoming unwell, she’d flirted with weight-loss injections. Further literature work turned up the first case reports, in 2023, of severe eosinophilic skin rashes with one of the medications widely in use as a weight-loss treatment. Petra assured me she’d stopped the injections before falling ill, so I explained my diagnosis and predicted she would soon recover. She didn’t. She kept returning with intolerable flares. More oral steroids were needed. Further literature searches revealed reports of lymphoma – a type of blood cancer – presenting identically to Dress. I became unnerved: had I been providing reassurance when what she needed was chemotherapy?
I took a skin biopsy: if lymphoma were present, there should be signs under the microscope. The local pathologist thought it was OK but he sent the specimen for a second opinion from a lymphoma expert. It took weeks to get the result: there was no sign of skin involvement from blood cancer.
Petra was delighted to get the news, but even more delighted to report that finally, after six torrid months, the rash had resolved, her swollen glands had shrunk and she no longer felt unwell. While most drugs are cleared from the body in a matter of days, the effects of weight-loss injections can persist for months.
The current enthusiasm for “skinny jabs” is likely to become tempered as their widespread use generates more insight into their potential downsides. For her part, Petra has resolved to tackle her weight in future through time-honoured, non-pharmaceutical means.
[See also: Did Labour let down abused women?]
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This article appears in the 27 Aug 2025 issue of the New Statesman, The Gentle Parent Trap