Vancomycin-induced DRESS syndrome treated with systemic steroids in a 16-year-old male

Abstract

This is a case report of a 16-year-old patient with DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) associated with vancomycin who improved with systemic steroid treatment. DRESS syndrome is a life-threatening disease process typically secondary to medications, such as anticonvulsants, sulfonamides, and allopurinol. Vancomycin has also been associated with this condition. Apart from discontinuation of the offending agent, there are no clear treatment guidelines, but reports of improvement with systemic corticosteroids are described. We present a case of a 16-year-old male who had been on vancomycin for greater than 4 weeks before developing symptoms consistent with the diagnosis of DRESS syndrome. Our patient demonstrated marked improvement with systemic corticosteroids.

Vancomycin-induced drug rash with eosinophilia and systemic symptoms (DRESS)

“…Other patients may present with only a mild elevation in liver function tests; these patients tend to be younger and healthier, like the one presented in this report 6 7. Previously published cases of vancomycin-induced DRESS report onset of symptoms after at least 3 weeks of antibiotic therapy 3–7. This suggests that patients who require greater duration of vancomycin therapy, such as those with endocarditis or osteomyelitis, are at greater risk of developing DRESS.…”

“…Hepatic compromise from vancomycin-induced DRESS can be variable, with some patients presenting with significant transaminitis 3–5. Other patients may present with only a mild elevation in liver function tests; these patients tend to be younger and healthier, like the one presented in this report 6 7. Previously published cases of vancomycin-induced DRESS report onset of symptoms after at least 3 weeks of antibiotic therapy 3–7.…”

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.…”