title: Two cases with HSS/DRESS syndrome developing after prosthetic joint surgery: does vancomycin-laden bone cement play a role in this syndrome?
abstract: We report two cases of hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (HSS/DRESS) syndrome following systemic and local (via antibiotic laden bone cement (ALBC)) exposures to vancomycin. Both cases developed symptoms 2-4 weeks after the initiation of treatment. They responded to systemic corticosteroid treatment and were cured completely. Various drug groups may cause HSS/DRESS syndrome, and vancomycin-related cases do not exceed 2-5% of the reported cases. Almost all of these cases developed the syndrome following systemic exposure to vancomycin. ALBC seems to be the safer antibiotic administration method, as systemic antibiotic levels did not reach a toxic threshold level. However, local administration may not always be sufficient for bone-related/joint-related infections; these infections may require systemic antibiotics as well. As HSS/DRESS syndrome can mimic infectious diseases, it must be considered during differential diagnosis before suspecting failure of treatment and initiation of a different antibiotic course.
authors.affiliation: Department of Pharmacology, Ufuk University Medical School, Ankara, Turkey.
authors.forename: Müberra Devrim
authors.initials: MD
authors.lastname: Güner
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Ufuk University Medical School, Ankara, Turkey.
authors.forename: Semra
authors.identifier: http://orcid.org/0000-0002-8860-5738
authors.initials: S
authors.lastname: Tuncbilek
authors.affiliation: Department of Orthopaedics, Ufuk University Medical School, Ankara, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Akan
authors.affiliation: Department of Internal Medicine, Ufuk University Medical School, Ankara, Turkey.
authors.forename: Aysun
authors.initials: A
authors.lastname: Caliskan-Kartal
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001843:Bone Cements / Q000009:adverse effects*; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D004802:Eosinophilia / Q000139:chemically induced* / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006633:Histamine Antagonists / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D013610:Tachycardia / Q000209:etiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001843:Bone Cements; D006633:Histamine Antagonists; D014640:Vancomycin