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Obadah Aqtash,1 Aman Naim Ajmeri,1 Brent A Thornhill,1 Elise Anderson,2 Ryan Carroll,1 Adee Elhamdani,1 Eva Tackett1 1Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA; 2Charleston Area Medical Center, Charelston, WV 25701, USACorrespondence: Aman Naim AjmeriInternal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA, Email ajmeri@marshall.eduAbstract: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially fatal severe adverse reaction to medications. Numerous drugs have been implicated, with carbamazepine and allopurinol being the most common. Tenofovir-induced DRESS is extremely rare. We report a case of a 65-year-old male patient with a diffuse exfoliative maculopapular rash across his entire body of five weeks of duration. The patient also had icteric sclera, abnormal liver enzymes and Raynaud’s of the tongue, nose and the left fifth finger. After discontinuation of tenofovir, the case resolved over a span of ten days. A high index of suspicion is crucial along with the prompt withdrawal of the offending medication for a good outcome.Keywords: DRESS, drug reaction with eosinophilia and systemic symptoms, tenofovir, tenofovir-induced DRESS, Raynaud’s phenomena, Raynaud’s of the tongue