title: [Strontium ranelate-induced DRESS syndrome].
abstract: BACKGROUND
  Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe form of adverse drug reaction. Strontium ranelate has recently been authorised for postmenopausal osteoporosis. We report a case of strontium ranelate-induced DRESS complicated by linear Ig A dermatosis due to vancomycin.
  
  
  METHODS
  A 77-year-old woman with osteoporosis had been treated by strontium ranelate for 4 weeks when she developed a febrile generalized skin rash. Blood tests showed eosinophilia (12.74 × 10(9)/L) and liver damage. A diagnosis of DRESS was made, leading to discontinuation of strontium ranelate and prescription of systemic corticosteroids. Two days later, methicillin-resistant Staphylococcus aureus bacteraemia occurred and treatment with vancomycin was started. The liver dysfunction resolved. After two weeks of antibiotherapy, bullous lesions were noted on the thighs. Skin biopsy results suggested a diagnosis of linear IgA bullous dermatosis. Vancomycin was stopped. Two weeks later, the eruption resolved. The eosinophil count gradually returned to normal after four months of corticosteroid therapy.
  
  
  CONCLUSIONS
  More than 15 cases of DRESS syndrome have been reported in Europe, including 2 deaths related to ranelate strontium, prompting European health authorities to publish a warning concerning the risk of strontium ranelate-induced DRESS. A particular feature of our patient was complication with linear IgA bullous dermatosis caused by vancomycin. In conclusion, it is essential to be aware of the risk of severe cutaneous reaction to strontium ranelate, a new drug used to treat osteoporosis.
authors.affiliation: Service de dermatologie, CHU Pontchaillou, rue H.-Le-Guilloux, 35033 Rennes cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Le Merlouette
authors.forename: H
authors.initials: H
authors.lastname: Adamski
authors.forename: M
authors.initials: M
authors.lastname: Dinulescu
authors.forename: F
authors.initials: F
authors.lastname: Le Gall
authors.forename: F
authors.initials: F
authors.lastname: Colin
authors.forename: H
authors.initials: H
authors.lastname: Grimaud
authors.forename: J
authors.initials: J
authors.lastname: Chevrant-Breton
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D016470:Bacteremia / Q000175:diagnosis; D001706:Biopsy; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000633:toxicity*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000188:drug therapy; D003875:Drug Eruptions / Q000175:diagnosis* / Q000188:drug therapy; D004802:Eosinophilia / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007070:Immunoglobulin A / Q000378:metabolism; D055624:Methicillin-Resistant Staphylococcus aureus; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000633:toxicity*; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012867:Skin / Q000473:pathology; D012872:Skin Diseases, Vesiculobullous / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D013203:Staphylococcal Infections / Q000175:diagnosis; D013577:Syndrome; D013876:Thiophenes / Q000008:administration & dosage / Q000633:toxicity*; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D050071:Bone Density Conservation Agents; D007070:Immunoglobulin A; D009942:Organometallic Compounds; D013876:Thiophenes; C081587:strontium ranelate; D014640:Vancomycin; D011241:Prednisone