Vancomycin-induced DRESS syndrome in a female patient.
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.


METHODS
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.


CONCLUSIONS
Vancomycin can be a cause of DRESS syndrome. A high index of suspicion is warranted in order not to miss this potentially lethal disease.
Vauthey
Laetitia
L
Orthopaedic Surgery Service, University Hospitals of Geneva, Geneva, Switzerland.
Uçkay
Ilker
I
Abrassart
Sophie
S
Bernard
Louis
L
Assal
Mathieu
M
Ferry
Tristan
T
Djordjevic
Marina
M
Roussos
Constantinos
C
Vaudaux
Pierre
P
D058186:Acute Kidney Injury / Q000139:chemically induced; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology*; D004802:Eosinophilia / Q000139:chemically induced; D005260:Female; D005334:Fever / Q000139:chemically induced; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D000068656:Mometasone Furoate; D011244:Pregnadienediols / Q000627:therapeutic use; D013577:Syndrome; D014640:Vancomycin / Q000009:adverse effects*
D018926:Anti-Allergic Agents; D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D011244:Pregnadienediols; D000068656:Mometasone Furoate; D014640:Vancomycin; D008775:Methylprednisolone