Abstract
We present a unique case of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome masquerading as elusive endocarditis. A 37-year-old female actively using intravenous drugs presented with worsening right upper extremity pain, fever, and chills. Workup revealed methicillin-resistant staphylococcus aureus (MRSA) bacteremia and multiple right-sided septic pulmonary emboli. Echocardiogram was negative for vegetation. Vancomycin was initiated for bacteremia management suspected secondary to right upper extremity abscesses. However, despite resolution of abscesses, fevers persisted, raising suspicion for endocarditis not detected by echocardiogram. On hospital day 25, the patient began showing signs of DRESS syndrome, ultimately manifesting as transaminitis, eosinophilia, and a diffuse, maculopapular rash. Vancomycin was switched to Linezolid and she improved on high dose steroids. The persistent fevers throughout this hospital course were thought to be an elusive endocarditis before DRESS syndrome fully manifested. Although Vancomycin-induced DRESS is uncommon, this case highlights the importance of identifying early signs of significant adverse effects.
Highlights
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is seldom seen, distinct, and a potentially life-threatening drug-induced Type IV hypersensitivity reaction that is frequently associated with reactivation of latent HHV-6 infections [1]
The pathogenesis includes an expansion of activated CD4 and CD8 cells which is thought to contribute to a reactivation of herpesvirus infections in most, not all, cases
We present a unique case of vancomycin-induced DRESS syndrome manifesting as an elusive endocarditis for several weeks before developing into florid eosinophilia and systemic symptoms
Summary
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is seldom seen, distinct, and a potentially life-threatening drug-induced Type IV hypersensitivity reaction that is frequently associated with reactivation of latent HHV-6 infections [1]. The pathogenesis includes an expansion of activated CD4 and CD8 cells which is thought to contribute to a reactivation of herpesvirus infections in most, not all, cases. The most commonly implicated agents include allopurinol and the anticonvulsive medications lamotrigine, carbamazepine, and phenytoin. Sulfonamides such as vancomycin are rarely associated with DRESS syndrome. We present a unique case of vancomycin-induced DRESS syndrome manifesting as an elusive endocarditis for several weeks before developing into florid eosinophilia and systemic symptoms
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
