Vancomycin induced DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) in a patient with tricuspid endocarditis

Abstract

A 57-year-old man presented for an elective pacemaker upgrade, complicated by the discovery of device infection. He had a background of complex congenital heart disease, including replacement of heart valves, and was treated for presumed infective endocarditis that was later confirmed by echocardiography. Antibiotic treatment, with intravenous vancomycin, was given as per the tissue sample sensitivities. On day 24 of treatment he deteriorated clinically, with the evolution of recurrent fever, epigastric pain, diarrhoea, widespread pruritic rash, lymphadenopathy and severe hypoxia over the subsequent 7–10 days. Blood tests revealed development of a marked eosinophilia, transaminitis and rising inflammatory markers. Further radiological imaging was non-diagnostic. On the basis of these clinical and biochemical features a diagnosis of drug reaction with eosinophilia and systemic symptoms syndrome was made. This led to the cessation of vancomycin, the offending agent and the referral for specialist immunology advice. He was subsequently treated with oral prednisolone and made a full recovery.

Glycolysis: An early marker for vancomycin‐specific T‐cell activation

“…Vancomycin‐induced DRESS can be severe and limit the choice of antibiotics for Gram‐positive bacterial infections. 18 , 19 The recent discovery of (i) HLA‐A*32:01 carriage as a susceptibility factor for vancomycin‐induced DRESS 9 and (ii) the detection of vancomycin‐responsive T cells in patients with DRESS and healthy HLA‐A*32:01+ donors 10 highlights the importance of adaptive immunity in disease pathogenesis. In this study, vancomycin‐reactive CD4+ and CD8+ TCCs were successfully generated from healthy donors and patients with vancomycin‐induced DRESS (Figure 1 ).…”

A rare case of infant eosinophilia induced by oral vancomycin: a case report and literature review

“…Table 3 and Table 4 present a summary and analysis of 44 cases of eosinophilia caused by vancomycin. 2–8,35–65 Of these 44 cases, drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome, was found in 35 cases. 2–8,35–57 In other cases, some patients had increased eosinophil counts an...…”

“…2–8,35–65 Of these 44 cases, drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome, was found in 35 cases. 2–8,35–57 In other cases, some patients had increased eosinophil counts and involvement of other organs such as kidney, lung and heart function due to intravenous use of vancomycin. 58,…”

“…58,62,63 Although the reported cases were been clearly diagnosed as DRESS, they were considered to have this syndrome based on the case data. A comprehensive review all of the 44 published cases with eosinophilia caused by vancomycin demonstrated the following (Table 4): 2–8,35–65 male patients were more often affected (27 of 44 patients; 61.4%); the median age was 46.8 years (range, 2 months to 59 years); the median time to vancomycin-related symptoms was 23.5 days (range, 3–49 days); and the median eosinophil count was 5.22 × 10 9 /l (range, 0.85–37.5 × 10 9 /l). Fever (32 of 44 patients; 72.7%) and/or rash (36 of 44 patients; 81.8%) were the first symptoms of eosinophilia in patients with vancomycin treatment; and another two cases had hypotension or were asymptomatic after intraperitoneal injection of vancomycin.…”

Trimetazidine, a hitherto unreported cause of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome

“…DRESS syndrome is an idiosyncratic life‐threatening multi‐organ hypersensitivity reaction that usually appears 2–6 weeks after drug exposure 1 . Most common culprit drugs are anticonvulsants (carbamazepine, lamotrigine, phenobarbital, phenytoin, valproate), antimicrobials (dapsone, rifampicin, isoniazid, cotrimoxazole, vancomycin), allopurinol, diuretics, non‐steroidal anti‐inflammatory drugs, antihypertensives (amlodipine and captopril), and antidepressants (fluoxetine, bupropion).…”