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It has been demonstrated that patients with DRESS related to sulfonamides have, in many cases, a high incidence of slow acetylators carrier status (low N-acetylation), which determines N-acetyl-transferase deficiency, resulting in the formation of excessive amounts of hydroxylamine metabolites, which reach toxic levels and are capable of causing cell damage and immune activation.19 In Taiwanese, Japanese and Malaysian populations, a CYP2C9*3 gene variant (capable of reducing phenytoin excretion) is frequently found and is especially associated with DRESS triggered by this medication use