TREATMENT OF DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) WITH MEPOLIZUMAB

Abstract

<h3>Introduction</h3> The standard treatment for DRESS involves stopping the culprit drug and often a prolonged course of systemic corticosteroids. Long-term systemic corticosteroids can have major adverse effects. We present a case of DRESS successfully managed with mepolizumab, an interleukin-5-antagonist, to decrease systemic corticosteroids. <h3>Case Description</h3> A 53-year-old male with a history of poorly controlled type 2 diabetes complicated by foot osteomyelitis was treated with vancomycin, ertapenem, and gabapentin. In three weeks, his absolute eosinophil count (AEC) increased to 1100/µL from a baseline of 300/µL. One week later he developed a diffuse morbilliform eruption, facial swelling, AEC of 2200/µL, and acute renal injury. He was diagnosed with DRESS. Vancomycin, ertapenem, and gabapentin were stopped, and he was treated with intravenous methylprednisolone. Vancomycin was presumed to be the likely culprit. By day 7 of hospitalization, his rash and creatinine improved and AEC decreased to 300/µL. He was discharged on oral prednisone 60mg and an adjusted insulin regimen due to elevated blood glucose. Two days post-discharge, his AEC increased to 3700/µL and he had persistent pruritus but improving rash. He was given mepolizumab 100mg and an oral corticosteroid taper. Within a week, AEC was zero. He was given a second dose of mepolizumab 100mg six weeks after the first dose as AEC increased to 900/µL. Three months post-discharge after a 7-week taper of steroids, he has not had recurrence of DRESS, AEC is ≤ 500/µL, and HbA1C remains within goal. <h3>Discussion</h3> Mepolizumab shows promise as a novel and safe steroid-sparing treatment for DRESS.