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Bhatt KP, Alsoud F, Prashad A, Ortega-Tola J, Singh VR, Patel P, Michel G. Drug reaction with eosinophilia and systemic symptoms (DRESS): an unusual manifestation of multi-visceral abnormalities and long-term outcome. Discoveries (Craiova) 2023; 11:e170. [PMID: 37680345 PMCID: PMC10482497 DOI: 10.15190/d.2023.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug induced hypersensitivity (DiHS) is a rare, however a severe hypersensitivity reaction with a mortality rate of up to 10%, accounting for 10 to 20% of all cutaneous drug reactions in hospitalized patients. The clinical features of DRESS/DiHS may be challenging to recognize and diagnose, since they are delayed, stepwise, and heterogeneous. The classic presentation of DRRSS/DiHS involves a combination of cutaneous, hematologic, and internal organ involvement with a 2 to 8 weeks latency between drug exposure and the onset of symptoms. Finding the culprit drug in our case was difficult as the patient was taking multiple antibiotics. Drugs such as vancomycin and cefepime used before the rash outbreak for post-reconstructive surgery for left toal knee arthroplasty (TKA) approximately four weeks before the onset of the rash are likely offending agents. This patient also had multi-visceral involvement with eosinophilia and systemic symptoms. The current treatment guidelines for DRESS/DiHS are primarily based on expert opinion, as no randomized control trials exist. After the prompt withdrawal of the offending drug, systemic corticosteroids seem to have shown the best outcome for patients. Delaying discontinuing offending medications and initiating corticosteroid treatment may lead to poor results. The present case emphasizes that the close observation of patients with drug eruption induced by antibiotics is imperative. Primary care team should be able to promptly diagnose patients with DRESS syndrome, detect causative drug, and play a crucial role in the timely evaluation and treatment to reduce mortality rate. The later phase disease relapse or autoimmune complications may occur up to 5 years following the initial presentation. Therefore, we advised the patient to have an outpatient follow up for appropriate testing, including but not limited to genetic susceptibility due to the high risk of relapse and emerging risk of autoimmune diseases.
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Affiliation(s)
| | | | | | | | | | - Pooja Patel
- Larkin Community Hospital, South Miami, FL, USA
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Chiang V, Wong JC, Yeung HH, Au EY, Li PH. DRESS syndrome induced by antibiotic-loaded bone cements and a diagnostic algorithm for related delayed-type hypersensitivity reactions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1029-1031.e1. [DOI: 10.1016/j.jaip.2020.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/17/2022]
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Cox M, Paviour S, Gregory S, Chew R. When fever is more than infection: two cases of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS). BMJ Case Rep 2021; 14:14/1/e238006. [PMID: 33414117 PMCID: PMC7797317 DOI: 10.1136/bcr-2020-238006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but serious systemic hypersensitivity reaction associated with a range of medications. We present two cases of vancomycin-induced DRESS, which occurred simultaneously in the orthopaedic ward in an outer metropolitan hospital. These cases demonstrate the complexity in the diagnosis and management of this inflammatory syndrome on the background of known infection as well as evidence for linezolid as an alternative to vancomycin. The first case was managed conservatively, but developed progressive renal and liver injury along with demonstrated cytomegalovirus reactivation and recurrent colitis, and was eventually palliated. The second was commenced on intravenous glucocorticoids and achieved remission, although had ongoing renal dysfunction at the time of discharge from outpatient follow-up.
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Affiliation(s)
- Mitchell Cox
- Orthopaedics Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Sophie Paviour
- Infectious Diseaes Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Sophie Gregory
- Orthopaedics Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Rusheng Chew
- Infectious Diseaes Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
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Sharifzadeh S, Mohammadpour AH, Tavanaee A, Elyasi S. Antibacterial antibiotic-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a literature review. Eur J Clin Pharmacol 2020; 77:275-289. [PMID: 33025080 PMCID: PMC7537982 DOI: 10.1007/s00228-020-03005-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
Background Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) is a delayed infrequent potentially life-threatening idiosyncratic drug reaction. Aromatic anticonvulsants and allopurinol are the most frequent causative agents. However, various reports of antibiotic-induced DRESS are available. In this review, we try to summarize reports of antibacterial antibiotic-induced DRESS focusing on characteristics of DRESS induced by each antibiotic group. Methods The data were collected by searching PubMed/MEDLINE and ScienceDirect. The keywords used as search terms were “DRESS syndrome,” “drug-induced hypersensitivity syndrome (DIHS),” “antibiotics,” “antimicrobial,” and names of various antimicrobial groups. Finally, 254 relevant cases with a definite or probable diagnosis of DRESS based on RegiSCAR criteria were found until 30 May 2020 and reviewed. Results and conclusion Totally, 254 cases of antibacterial antibiotic-induced DRESS are reported. Most of them are related to antituberculosis drugs, vancomycin, and sulfonamides, respectively. Rash and fever were most frequent clinical findings. Eosinophilia and liver injury were the most reported hematologic and visceral organ involvement, respectively. Most of the patients are managed with systemic corticosteroids. The death occurred in 16 patients which most of them experienced liver or lung involvement. The reactivation of various viruses especially HHV-6 is reported in 33 cases. The mean latency period was 29 days. It is necessary to perform thorough epidemiological, genetic, and immunological studies, also systematic case review and causality assessment, as well as well-designed clinical trials for better management of antibiotic-induced DRESS. Electronic supplementary material The online version of this article (10.1007/s00228-020-03005-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiva Sharifzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box 91775-1365, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box 91775-1365, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ashraf Tavanaee
- Department of Infectious Disease, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box 91775-1365, Mashhad, Iran.
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Mitchell B, Girard PJ, Kent WT. Antibiotic-Impregnated Intramedullary Cement Nail-Induced Acute Generalized Exanthematous Pustulosis and Septic Shock: A Case Report. JBJS Case Connect 2020; 10:e0441. [PMID: 32649114 DOI: 10.2106/jbjs.cc.19.00441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 28-year-old woman with an infected proximal femur nonunion was treated with an antibiotic-coated intramedullary nail. Shortly after discharge, the patient presented to the emergency department and was readmitted with a morbilliform rash sparing the left lower extremity. She became hemodynamically unstable, despite cessation of intravenous antibiotics, requiring transfer to the intensive care unit and urgent removal of her antibiotic nail. She improved after surgery, and biopsy results from the rash confirmed acute generalized examthematous pustulosis. CONCLUSION Acute generalized exanthematous pustulosis is a rare, dermatologic crisis that can be precipitated by antibiotics, even in the form of antibiotic cement.
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Affiliation(s)
- Brendon Mitchell
- 1Department of Orthopedic Surgery, University of California-San Diego, San Diego, California
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Glycopeptide Hypersensitivity and Adverse Reactions. PHARMACY 2020; 8:pharmacy8020070. [PMID: 32326261 PMCID: PMC7357119 DOI: 10.3390/pharmacy8020070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/23/2020] [Accepted: 04/18/2020] [Indexed: 12/27/2022] Open
Abstract
Glycopeptides, such as vancomycin and teicoplanin, are primarily used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, such as cellulitis, endocarditis, meningitis, pneumonia, and septicemia, and are some of the most commonly prescribed parenteral antimicrobials. Parenteral glycopeptides are first-line therapy for severe MRSA infections; however, oral vancomycin is used as a first-line treatment of Clostridioides difficile infections. Also, we currently have the longer-acting lipoglycopeptides, such as dalbavancin, oritavancin, and telavancin to our armamentarium for the treatment of MRSA infections. Lastly, vancomycin is often used as an alternative treatment for patients with β-lactam hypersensitivity. Common adverse effects associated with glycopeptide use include nephrotoxicity, ototoxicity, and Redman Syndrome (RMS). The RMS is often mistaken for a true allergy; however, it is a histamine-related infusion reaction rather than a true immunoglobulin E (IgE)-mediated allergic reaction. Although hypersensitivity to glycopeptides is rare, both immune-mediated and delayed reactions have been reported in the literature. We describe the various types of glycopeptide hypersensitivity reactions associated with glycopeptides and lipoglycopeptides, including IgE-mediated reactions, RMS, and linear immunoglobulin A bullous dermatosis, as well as describe cross-reactivity with other glycopeptides.
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Vancomycin-associated drug-induced hypersensitivity syndrome. J Am Acad Dermatol 2019; 81:123-128. [DOI: 10.1016/j.jaad.2019.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/13/2019] [Accepted: 02/01/2019] [Indexed: 12/17/2022]
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Harper KD, Incavo SJ. Drug reaction with eosinophilia and systemic symptoms syndrome after total knee arthroplasty infection and placement of antibiotic spacer. Arthroplast Today 2019; 5:148-151. [PMID: 31286034 PMCID: PMC6588817 DOI: 10.1016/j.artd.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/15/2019] [Accepted: 04/16/2019] [Indexed: 12/20/2022] Open
Abstract
Though 2-stage revision is considered the gold standard in North America for treatment of periprosthetic joint infection, complications can be associated with use of antibiotic-impregnated spacers. We present a unique case of drug reaction with eosinophilia and systemic symptoms syndrome in a patient with retained antibiotic-impregnated spacer placed for the treatment of a periprosthetic joint infection. Although drug reactions in general are common, severe drug reactions like the one described in this article are exceedingly rare. After discontinuation of intravenous antibiotics and the initiation of corticosteroids, the patient’s symptoms resolved, despite retention of the spacer. Steroid administration and supportive care may result in resolution of symptoms without the need for surgical intervention for spacer removal.
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Affiliation(s)
- Katharine D. Harper
- Corresponding author. 6445 Main Street, Suite 2500, Houston, TX 77030, USA. Tel.: +1 267 265 5460.
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Nartker N, Kudlak N, Crowe D. Linear IgA bullous dermatosis protracted by vancomycin-loaded bone cement. JAAD Case Rep 2019; 5:234-236. [PMID: 30847379 PMCID: PMC6389549 DOI: 10.1016/j.jdcr.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Wilcox O, Hassanein M, Armstrong J, Kassis N. Case report: atypical presentation of vancomycin induced DRESS syndrome: a case report and review of the literature. BMC Pulm Med 2017; 17:217. [PMID: 29282040 PMCID: PMC5745618 DOI: 10.1186/s12890-017-0564-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/15/2017] [Indexed: 12/18/2022] Open
Abstract
Background Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity drug reaction involving the skin and multiple internal organ systems. The symptoms typically present with fever and skin rash, and rapidly progress to multiple organ failures. Vancomycin is a rare drug to cause DRESS syndrome with 23 cases reported to date. Case presentation We described a case of a 39 year-old man who was treated with vancomycin for osteomyelitis of the foot. The patient subsequently developed acute respiratory distress syndrome (ARDS) followed by rash and acute interstitial nephritis. These symptoms were improved by withdrawal of vancomycin and a pulsed corticosteroid regimen. According to the European Registry of Severe Cutaneous Adverse Reaction Criteria (RegiSCAR) (Kardaun et al, British Journal of Dermatology, 169:1071-1080, 2013), the probability of vancomycin induced DRESS syndrome was scored as “Definite”. A literature search of vancomycin induced DRESS syndrome was also performed and the overall pulmonary involvement was estimated as 5%. To our knowledge, this was the first case reported with pulmonary involvement as the initial symptom. Conclusion This is the first case to report pulmonary manifestation as the initial symptom in vancomycin induced DRESS syndrome. Prompt recognition of this entity can expedite proper treatment and hasten recovery. Electronic supplementary material The online version of this article (10.1186/s12890-017-0564-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olivia Wilcox
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| | - Mohamed Hassanein
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| | - John Armstrong
- Pulmonary Critical Care, Sparrow Medical Group, Lansing, MI, USA
| | - Nader Kassis
- Nephrology, Sparrow Medical Group, Lansing, MI, USA.
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Athans V, Veve MP, Davis SL. Trowels and Tribulations: Review of Antimicrobial-Impregnated Bone Cements in Prosthetic Joint Surgery. Pharmacotherapy 2017; 37:1565-1577. [DOI: 10.1002/phar.2040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Vasilios Athans
- Department of Pharmacy Services; Cleveland Clinic; Cleveland Ohio
| | - Michael P. Veve
- Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
- Department of Pharmacy Services; Henry Ford Hospital; Detroit Michigan
| | - Susan L. Davis
- Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
- Department of Pharmacy Services; Henry Ford Hospital; Detroit Michigan
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Drug eruption secondary to vancomycin-laden spacer in the shoulder: a case report. J Shoulder Elbow Surg 2016; 25:e236-40. [PMID: 27422463 DOI: 10.1016/j.jse.2016.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/18/2016] [Indexed: 02/01/2023]
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