Abstract
BackgroundDrug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a relatively rare clinical entity; even more so in response to vancomycin.MethodsCase report.ResultsWe present a severe case of vancomycin-induced DRESS syndrome, which on presentation included only skin, hematological and mild liver involvement. The patient further developed severe acute interstitial nephritis, eosinophilic pneumonitis, central nervous system (CNS) involvement and worsening hematological abnormalities despite immediate discontinuation of vancomycin and parenteral corticosteroids. High-dose corticosteroids for a prolonged period were necessary and tapering of steroids a challenge due to rebound-eosinophilia and skin involvement.ConclusionPatients with DRESS who are relatively resistant to corticosteroids with delayed onset of certain organ involvement should be treated with a more prolonged corticosteroid tapering schedule. Vancomycin is increasingly being recognized as a culprit agent in this syndrome.
Highlights
We present a case of severe Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) [1] syndrome secondary to vancomycin, with associated multiorgan dysfunction
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is an idiosyncratic hypersensitivity response characterized by a maculopapular erythematous eruption that typically develops 2-6 weeks following initiation of the culprit drug
We present a case of a patient with a relatively severe DRESS syndrome secondary to vancomycin with multiple organ systems affected, including skin, hematological, liver, lung, brain and kidneys in a stepwise fashion
Summary
We present a case of severe Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) [1] syndrome secondary to vancomycin, with associated multiorgan dysfunction. Case Report A 66 year-old male presented to the emergency department (ED) with a one-week history of progressive pruritic erythematous rash, dry cough and two days of episodic high fevers He had suffered a fall 12 weeks prior that had resulted in a pelvic fracture requiring an open-reduction internal fixation, which subsequently became infected with methicillin-resistant Staphylococcus aureus (MRSA) and treatment with intravenous. His past medical history was significant for heterozygous hemochromatosis, a remote splenectomy secondary to traumatic rupture, and non-anaphylactic adverse reactions to penicillin and sulfa antibiotics. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a relatively rare clinical entity; even more so in response to vancomycin
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