Vancomycin-Induced DRESS Syndrome in a Female Patient

Abstract

Background: DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a hypersensitivity reaction with skin rashes, eosinophilia, fever, lymph node enlargement and internal organ involvement. Case Report: A 60-year-old diabetic woman was hospitalized at the University Hospitals of Geneva for mid-leg amputation due to peripheral arterial occlusive disease. No drug allergy was reported. Because of a wound infection by methicillin-resistant Staphylococcus aureus, treatment with vancomycin (2 g/day) in continuous perfusion was initiated. Approximately 2 weeks later, she developed a toxidermia with fever, a progressive maculopapular skin rash, eosinophilia and acute renal insufficiency. The skin biopsy revealed a necrosis with lymphocytic and eosinophilic infiltrations, supporting the suspicion of DRESS syndrome. A cure was achieved by the withdrawal of vancomycin and the administration of methylprednisolone (1 g/day), antihistaminics and topical mometasone, without the introduction of other antibiotics. Conclusion: Vancomycin can be a cause of DRESS syndrome. A high index of suspicion is warranted in order not to miss this potentially lethal disease.

Systemic Toxicity of Intraperitoneal Vancomycin

“…Our patient certainly had some of these symptoms but in addition had a prominent rash with lymphocytic and eosinophilic infiltrate and we feel his presentation is most consistent with DRESS syndrome. DRESS syndrome is felt to be a separate entity from IgE mediated anaphylaxis and is characterized by T cell activation which is often accompanied by eosinophilia along with high fever and multiorgan involvement as was seen in our patient [11]. DRESS syndrome often presents after weeks of exposure to a medication and responds to corticosteroids in keeping with our patient's course.…”

A Newborn with Vancomycin-Induced Thrombocytopenia

“…We have read with great interest the article by Vauthey et al [1] , entitled 'Vancomycin-induced DRESS syndrome in a female patient'. They reported a 60-year-old diabetic woman with mid-leg amputation due to peripheral arterial occlusive disease.…”

Retrospective analysis of drug-induced hypersensitivity syndrome: A study of 27 patients

“…Hematologic (lymphadenopathy, eosinophilia, and atypical lymphocytosis) and hepatic (elevation of serum transaminases) manifestations are frequently reported. Multiple drugs have been described in case reports and case series to cause this reaction, including anticonvulsants 2 (eg, phenytoin, carbamazepine, lamotrigine, valproic acid), antimicrobials (eg, vancomycin, 3 antituberculous drugs, 4 Abbreviations used:…”