title: Liver transplantation in a child with acute liver failure resulting from drug rash with eosinophilia and systemic symptoms syndrome.
abstract: Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by a severe idiosyncratic reaction including rash and fever, often with associated hepatitis, arthralgias, lymph node enlargement, or hematologic abnormalities. The mortality rate is approximately 10%, primarily owing to liver failure with massive or multiple disseminated focal necrosis. Here, we report a case of a 14-year-old girl treated with vancomycin because of a wound infection by methicillin-resistant Staphylococcus aureus, who presented with non-specific symptoms, which progressed to acute liver failure, displaying the hallmarks of DRESS syndrome. With the presence of aggravated hepatic encephalopathy and azotemia, the patient was refractory to medical treatments, she received a living-donor liver transplantation, and a cure was achieved without any sign of recurrence. Vancomycin can be a cause of DRESS syndrome. A high index of suspicion and rapid diagnosis are necessary not to miss this potentially lethal disease.
authors.affiliation: Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seung Min
authors.initials: SM
authors.lastname: Song
authors.forename: Min Sung
authors.initials: MS
authors.lastname: Cho
authors.forename: Seak Hee
authors.initials: SH
authors.lastname: Oh
authors.forename: Kyung Mo
authors.initials: KM
authors.lastname: Kim
authors.forename: Young Seo
authors.initials: YS
authors.lastname: Park
authors.forename: Dae Yeon
authors.initials: DY
authors.lastname: Kim
authors.forename: Sung Gyu
authors.initials: SG
authors.lastname: Lee
keywords: Acute liver failure; DRESS syndrome; Liver transplantation; Vancomycin