title: DRESS syndrome presenting after initiation of mycobacterium avium complex osteomyelitis treatment.
abstract: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is characterised by fever, rash, eosinophilia and organ damage that develops 2-6 weeks after the initiation of a medication. We report a case of DRESS syndrome in a 79-year-old man that developed after the introduction of rifabutin, ethambutol and clarithromycin used to treat Mycobacterium avium complex (MAC) vertebral osteomyelitis. This case highlights treatment and management challenges in a patient with known MAC vertebral osteomyelitis requiring prolonged steroids. Steroids are the mainstays of treatment for moderate to severe cases of DRESS syndrome. Initiation of steroids for the treatment of DRESS syndrome among patients with concomitant infections requires multidisciplinary collaboration for optimal management.
authors.affiliation: School of Medicine and Health Sciences, George Washington University, Washington DC, USA.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Blair
authors.affiliation: School of Medicine and Health Sciences, George Washington University, Washington DC, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Herrin
authors.affiliation: School of Medicine and Health Sciences, George Washington University, Washington DC, USA.
authors.forename: Nawaf
authors.initials: N
authors.lastname: Abaalkhail
authors.affiliation: School of Medicine and Health Sciences, George Washington University, Washington DC, USA.
authors.forename: Wesley
authors.initials: W
authors.lastname: Fiser
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D017291:Clarithromycin / Q000008:administration & dosage / Q000009:adverse effects; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D004977:Ethambutol / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D015269:Mycobacterium avium Complex / Q000187:drug effects*; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy*; D010019:Osteomyelitis / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use*; D017828:Rifabutin / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017828:Rifabutin; D004977:Ethambutol; D017291:Clarithromycin; D011241:Prednisone