title: Enigma: infection or allergy? Vancomycin-induced DRESS syndrome with dialysis-dependent renal failure and cardiac arrest.
abstract: A man aged 73 years with infective endocarditis presented with septic shock and was started on immediate antimicrobial therapy. His blood culture yielded no organism. Subsequently, he developed a severe allergic reaction to prolonged empirical vancomycin therapy. This manifested as fever, widespread maculopapular rash and severe progressive acute kidney injury ultimately requiring dialysis. In the context of eosinophilia, this was determined to be drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Deciphering this complication as allergy in the context of severe infection required extreme caution due to the polarity of treatment with immunosuppression. Ultimately, this was used, with improvement of renal function, resolution of symptoms and absence of recurrence of infection. In summary, we present a case of vancomycin-related DRESS syndrome leading to dialysis-which is unique in the literature-complicating the treatment of culture-negative infective endocarditis.
authors: Department of Academic Research, Sheffield Teaching Hospitals, Sheffield, South Yorkshire, UK.
authors: Philip Simon
authors: http://orcid.org/0000-0003-1391-6707
authors: PS
authors: Webb
authors: Northern General Hospital, Sheffield, South Yorkshire, UK.
authors: Abdallah
authors: A
authors: Al-Mohammad
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D063926:Drug Hypersensitivity Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006323:Heart Arrest / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D006435:Renal Dialysis; D014640:Vancomycin / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D014640:Vancomycin; D011239:Prednisolone