26780 Patient experiences with teledermatology during the COVID-19 pandemic: A survey

Abstract

Drug-induced hypersensitivity syndrome (DIHS) is a life-threatening severe cutaneous adverse reaction with multisystem involvement. DIHS usually occurs in the context of orally or intravenously administered medications, but can be reactivated with epicutaneous application of culprit medications. We present a case of a 31-yearold woman who developed vancomycin-induced DIHS after treatment of a prosthetic joint infection. Her total hip arthroplasty prosthesis infection was treated with removal of the prosthesis, IV vancomycin and implantation of a polymethyl methacrylate vancomycin-eluting spacer along with vancomycin-eluting absorbable calcium beads. 26 days after treatment, she developed a pruritic morbilliform exanthema along with malaise, nausea, dysphagia, neck-swelling, chills and was noted to have an AST of 389 and an ALT of 338. IV vancomycin was replaced with daptomycin and patient was started on 100mg of daily prednisolone. After initiation of prednisolone, she had rapid improvement of her neck-swelling and rash, but her AST and ALT remained elevated for 10 days despite treatment with corticosteroids. Given her persistently elevated AST and ALT, multidisciplinary discussions were held to consider removing the implanted vancomycin-eluting spacer. Surgery was deferred due to the patient's high dose corticosteroids, increased risk of infection and incremental clinical improvement. She continued to improve and eventually tapered off her steroids after discharge. This is the first reported case of DIHS in a patient treated with drug-eluting absorbable beads, implant and IV antibiotics. In conclusion, we recommend careful consideration of the relative risks and benefits along with close clinical monitoring before surgical revision in complex cases of DIHS.