Vancomycin and DRESS: A retrospective chart review of 32 cases in Los Angeles, California

Lam, Barbara D.; Miller, Marina; Sutton, Adam; Peng, David H.; Crew, Ashley

doi:10.1016/j.jaad.2017.05.041

Cited by 18 publications

(8 citation statements)

References 6 publications

(3 reference statements)

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“…In addition, there was some confusion in the cause of DRESS syndrome because the vancomycin and warfarin were started around the same time. However, vancomycin has been identified to be a common etiology for DRESS in multiple reports whereas no case reports exist for warfarin [17]. In fact, one report demonstrated warfarin tolerance in a patient with acenocoumarol-induced DRESS [18].…”

Section: Discussionmentioning

confidence: 99%

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

Nguyen¹,

Ahmed²

2018

Cureus

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We present the case of a 62-year-old Caucasian man who was being treated for mitral valve endocarditis via a six-week course of vancomycin. On Day 32 of the treatment, he developed an erythematous, pruritic, desquamating, and painful rash covering 80% of the total body surface area and intermittent fevers. Laboratory findings included leukocytosis with peripheral blood eosinophilia and elevated erythrocyte sedimentation rate, C-reactive protein, and serum creatinine.Although the patient only completed five weeks of antibiotics, the decision was made to not complete the six-week antibiotic course due to suspicion of vancomycin-induced drug rash with eosinophilia and systemic symptoms (DRESS). The patient was then given 80 mg of intramuscular triamcinolone (Kenalog) and advised to apply topical 0.1% triamcinolone twice per day. At the three-month follow-up, the rash, leukocytosis, eosinophilia, and renal dysfunction had resolved. Clinicians must maintain a high index of suspicion for vancomycin-induced DRESS in patients with rash and eosinophilia for early recognition and treatment.DRESS syndrome treatment typically involves discontinuing the causative drug and promptly administering steroids. However, there is a therapeutic dilemma in administering steroids during the course of an active infection. Therefore, this article serves two purposes. First, this case report highlights our approach towards managing a patient with DRESS and concurrent infectious endocarditis. Second, we include a review of the management considerations when prescribing pulsed steroids so that clinicians have a single source as a practical guide towards reducing the potentially severe systemic sequelae in DRESS syndrome and its associated treatment.

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Section: Discussionmentioning

confidence: 99%

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

Nguyen¹,

Ahmed²

2018

Cureus

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“…A case series identified vancomycin as the commonest agent, causing 37.5% of DRESS over a three-year period [5]. DRESS syndrome is treated with immediate cessation of the causative agent and a prolonged course of tapering dose steroids; 1-2 mg/kg in one or two divided doses of prednisolone is the standard treatment dose [7]. In case 2, our dilemma was to commence steroids in the presence of deep spinal infection, and balance steroids were not prescribed after consultation with the intensivist.…”

Section: Casementioning

confidence: 99%

Drug Reaction, Eosinophilia, and Systemic Symptoms (DRESS) Syndrome As a Mimicker of Spinal Infection: Awareness for Spinal Surgeons

Mohammed

Panikkar

Elmalky

2020

Cureus

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Drug reaction, eosinophilia, and systemic symptoms (DRESS) syndrome is a delayed severe drug hypersensitivity (type IVb) syndrome with cutaneous eruption, hematological abnormalities, and multi-organ involvement. The wide spectrum of the disease manifestations, long-term sequelae, and high mortality rates are a clinical concern. Though not commonly reported in spinal surgery patients, the use of long-term antibiotics is a potential causative agent in spinal infections. DRESS syndrome can mimic systemic spinal infections, and clinical diagnosis requires high awareness and extreme vigilance. Prompt recognition and appropriate action can mitigate the potential poor outcomes and improve patient prognosis.

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“…It is characterized by early‐ or late‐onset fever, rash, and internal organ involvement . Vancomycin was shown to be one of the most common causes of DRESS according to a recent hospital‐based case series …”

Section: Introductionmentioning

confidence: 99%

“…1 Vancomycin was shown to be one of the most common causes of DRESS according to a recent hospital-based case series. 2 The immune mechanism of many drugs causing DRESS has been associated with HLA haplotype, which may explain why some drugs cause DRESS more frequently in different populations.…”

Section: Introductionmentioning

confidence: 99%

Haplotype analysis in a 16‐year‐old boy with vancomycin‐induced DRESS syndrome

Ercan

Yeşillik

Demirel

et al. 2019

Pediatric Dermatology

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but life‐threatening multisystem adverse reaction to a medication, with vancomycin being one of the most common cause reported. We present the HLA analysis of a pediatric patient who developed DRESS related to vancomycin and compared the results with the available literature. With further data, the use of pretreatment HLA analysis to prevent vancomycin related DRESS may be a valuable option in the near future.

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Vancomycin and DRESS: A retrospective chart review of 32 cases in Los Angeles, California

Cited by 18 publications

References 6 publications

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

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

Drug Reaction, Eosinophilia, and Systemic Symptoms (DRESS) Syndrome As a Mimicker of Spinal Infection: Awareness for Spinal Surgeons

Haplotype analysis in a 16‐year‐old boy with vancomycin‐induced DRESS syndrome

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