BMJ Case Reports 2018; doi:10.1136/bcr-2018-227378
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Case of drug reaction with eosinophilia and systemic symptoms secondary to vancomycin

  1. Alexei Gonzalez-Estrada3
  1. 1Department of Medicine, Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic’s Campus in Florida, Jacksonville, Florida, USA
  2. 2Pathology, East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA
  3. 3Division of Allergy and Clinical Immunology, Department of Medicine, East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA
  1. Correspondence to Dr Alexei Gonzalez-Estrada, gonzalez.alexei{at}
  • Accepted 20 September 2018
  • Published 8 October 2018


A 38-year-old man with a medical history of hepatitis C presented with a 2-day pruritic rash. It started on his back and generalised within 2 days. The patient had been on vancomycin for the last 3 weeks due to a recent diagnosis of osteomyelitis. He was not taking other medications. On physical examination, a diffuse blanching maculopapular exanthema was noted (figure 1A and B) associated to facial angioedema and palpable axillary and inguinal lymph nodes. Laboratory evaluation was relevant for leucocytosis with neutrophilia and eosinophilia, mild elevation of liver function tests and peripheral blood smear revealing atypical lymphocytes (figure 2). Skin biopsy demonstrated superficial perivascular …

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