Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Masquerading as Elusive Sepsis
We present a unique case of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome masquerading as elusive endocarditis. A 37-year-old female actively using intravenous drugs presented with worsening right upper extremity pain, fever, and chills. Workup revealed me...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Immunology |
| Online Access: | http://dx.doi.org/10.1155/2019/1625010 |
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| author | Sumon Roy Vinay P. Goswamy Kirolos N. Barssoum Devesh Rai |
| author_facet | Sumon Roy Vinay P. Goswamy Kirolos N. Barssoum Devesh Rai |
| author_sort | Sumon Roy |
| collection | DOAJ |
| description | We present a unique case of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome masquerading as elusive endocarditis. A 37-year-old female actively using intravenous drugs presented with worsening right upper extremity pain, fever, and chills. Workup revealed methicillin-resistant staphylococcus aureus (MRSA) bacteremia and multiple right-sided septic pulmonary emboli. Echocardiogram was negative for vegetation. Vancomycin was initiated for bacteremia management suspected secondary to right upper extremity abscesses. However, despite resolution of abscesses, fevers persisted, raising suspicion for endocarditis not detected by echocardiogram. On hospital day 25, the patient began showing signs of DRESS syndrome, ultimately manifesting as transaminitis, eosinophilia, and a diffuse, maculopapular rash. Vancomycin was switched to Linezolid and she improved on high dose steroids. The persistent fevers throughout this hospital course were thought to be an elusive endocarditis before DRESS syndrome fully manifested. Although Vancomycin-induced DRESS is uncommon, this case highlights the importance of identifying early signs of significant adverse effects. |
| format | Article |
| id | doaj-art-fde7a26af98d44c68e68fa741c639157 |
| institution | Kabale University |
| issn | 2090-6609 2090-6617 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Immunology |
| spelling | doaj-art-fde7a26af98d44c68e68fa741c6391572025-02-03T06:13:17ZengWileyCase Reports in Immunology2090-66092090-66172019-01-01201910.1155/2019/16250101625010Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Masquerading as Elusive SepsisSumon Roy0Vinay P. Goswamy1Kirolos N. Barssoum2Devesh Rai3Department of Medicine, Rochester General Hospital, Rochester Regional Health System, Rochester, NY 14621, USADepartment of Medicine, Rochester General Hospital, Rochester Regional Health System, Rochester, NY 14621, USADepartment of Medicine, Rochester General Hospital, Rochester Regional Health System, Rochester, NY 14621, USADepartment of Medicine, Rochester General Hospital, Rochester Regional Health System, Rochester, NY 14621, USAWe present a unique case of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome masquerading as elusive endocarditis. A 37-year-old female actively using intravenous drugs presented with worsening right upper extremity pain, fever, and chills. Workup revealed methicillin-resistant staphylococcus aureus (MRSA) bacteremia and multiple right-sided septic pulmonary emboli. Echocardiogram was negative for vegetation. Vancomycin was initiated for bacteremia management suspected secondary to right upper extremity abscesses. However, despite resolution of abscesses, fevers persisted, raising suspicion for endocarditis not detected by echocardiogram. On hospital day 25, the patient began showing signs of DRESS syndrome, ultimately manifesting as transaminitis, eosinophilia, and a diffuse, maculopapular rash. Vancomycin was switched to Linezolid and she improved on high dose steroids. The persistent fevers throughout this hospital course were thought to be an elusive endocarditis before DRESS syndrome fully manifested. Although Vancomycin-induced DRESS is uncommon, this case highlights the importance of identifying early signs of significant adverse effects.http://dx.doi.org/10.1155/2019/1625010 |
| spellingShingle | Sumon Roy Vinay P. Goswamy Kirolos N. Barssoum Devesh Rai Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Masquerading as Elusive Sepsis Case Reports in Immunology |
| title | Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Masquerading as Elusive Sepsis |
| title_full | Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Masquerading as Elusive Sepsis |
| title_fullStr | Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Masquerading as Elusive Sepsis |
| title_full_unstemmed | Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Masquerading as Elusive Sepsis |
| title_short | Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Masquerading as Elusive Sepsis |
| title_sort | vancomycin induced drug reaction with eosinophilia and systemic symptoms dress syndrome masquerading as elusive sepsis |
| url | http://dx.doi.org/10.1155/2019/1625010 |
| work_keys_str_mv | AT sumonroy vancomycininduceddrugreactionwitheosinophiliaandsystemicsymptomsdresssyndromemasqueradingaselusivesepsis AT vinaypgoswamy vancomycininduceddrugreactionwitheosinophiliaandsystemicsymptomsdresssyndromemasqueradingaselusivesepsis AT kirolosnbarssoum vancomycininduceddrugreactionwitheosinophiliaandsystemicsymptomsdresssyndromemasqueradingaselusivesepsis AT deveshrai vancomycininduceddrugreactionwitheosinophiliaandsystemicsymptomsdresssyndromemasqueradingaselusivesepsis |