DRESS syndrome presenting after initiation ofmycobacterium aviumcomplex 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.

Drug Rash with Eosinophilia and Systemic Symptoms Syndrome Presenting After the Initiation of Staphylococcus hominis Infectious Endocarditis Treatment: A Case Report and Updated Review of Management Considerations

“…One report demonstrated the successful management of DRESS syndrome in the course of infectious endocarditis involving intravenous immunoglobulins, N-acetylcysteine, montelukast, and gentamicin, while avoiding systemic corticosteroids [15]. Previous cases have been successful in discontinuing the antibiotics and starting high-dose steroid treatment following negative blood and urine cultures in osteomyelitis [16]. Randomized controlled clinical trials are lacking and are necessary for identifying optimal treatment strategies for DRESS syndrome.…”

Macrolide Allergic Reactions

“…Fourteen patients were reported to have anaphylactic reactions to a macrolide [19,23,59,66,73,74,81,98,100,108,121,132]. Drug reaction with eosinophilia and systemic symptoms syndrome was reported in four patients who received azithromycin and one patient who received clarithromycin [105,118,120,124,129]. Erythromycin (n = 1), clarithromycin (n = 2), and azithromycin (n = 1) have been implicated in leukocytoclastic vasculitis [60,79,84,113].…”

“…Erythromycin (n = 1), clarithromycin (n = 2), and azithromycin (n = 1) have been implicated in leukocytoclastic vasculitis [60,79,84,113]. Fourteen publications implicated a macrolide as the cause of an allergic reaction with subjects who received concomitant antimicrobials [25,41,44,45,46,58,76,78,90,101,102,105,119,131]. The most common concomitant agents were an aminoglycoside (n = 3), a beta-lactam (n = 3), and a sulfa (n = 4) [41,44,45,46,78,90,101,102,119,131].…”