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  • Vancomycin-associated drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: masquerading under the guise of sepsis

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Reminder of important clinical lesson
CASE REPORT
Vancomycin-associated drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: masquerading under the guise of sepsis
  1. Luke Maxfield1,
  2. Toni Schlick2,
  3. Angela Macri3,
  4. James Thatcher4
  1. 1Transitional Rotating Internship, Sampson Regional Medical Center, Clinton, NC, USA
  2. 2College of Medicine, Campbell University College of Osteopathic Medicine, Clinton, North Carolina, USA
  3. 3Dermatology, Sampson Regional Medical Center, Clinton, North Carolina, USA
  4. 4Family Medicine, Sampson Regional Medical Center, Clinton, NC, USA
  1. Correspondence to Dr Luke Maxfield, luke.maxfield{at}Med.lecom.edu

Summary

A patient presented with what appeared to be severe urosepsis. After admission and antibiotic administration, a newly developed rash and subsequent facial swelling appeared to be a reaction to penicillin class antibiotics. However, despite changing class of therapy with continued antimicrobial coverage, end organ damage continued, the rash worsened and facial oedema developed. Drug reaction with eosinophilia and systemic symptoms was ultimately diagnosed and was consistent with clinical and histopathological findings, as well as meeting all criteria for scoring systems. The patient was started on intravenous methylprednisolone 125 mg per 8 hours with rapid improvement of rash, swelling and end organ damage. Initial challenge to decrease dose failed, but the patient was ultimately able to be discharged on an extended taper.

  • dermatology
  • unwanted effects / adverse reactions

https://doi.org/10.1136/bcr-2017-221898

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    Footnotes

    • Contributors LM: involved in the patient’s care and acquisition of data, compilation of patient information, editing and formalising discussion, editing for journal format, is the corresponding author, and approved the final draft upon submission and agree to the integrity of the article. TS: involved in the patient’s care and acquisition of data, initial compilation of discussion section, review and editing of manuscript, and approved the final draft upon submission and agree to the integrity of the article. AM: involved in the patient’s care and acquisition of data, dermatology review and contributor of discussion of diagnosis, treatment and biopsy results, and approved the final draft upon submission and agree to the integrity of the article. JT: involved in the patient’s care and acquisition of data, review and editing of the manuscript, approved the final draft upon submission and agree to the integrity of the article.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.