Vancomycin DRESS

A 14-year-old boy developed a drug rash with eosinophilia and systemic symptoms (DRESS) and neutropenia after receiving vancomycin for 3 weeks [60 ]. Pediatric reports of DRESS are rare, and the clinical picture in this case resembled toxic shock syndrome. 

A 60-year-old woman with polyarthritis taking sulfasalazine developed a drug rash with eosinophilia and systemic symptoms (DRESS) with acute liver failure after taking vancomycin for 2 days [99" ]. After liver transplantation and initial recovery, hepatitis recurred. Lymphocytes and eosinophils were detected post-mortem in the... 

Mennicke M, Zawodniak A, Keller M, Wilkens L, Yawalkar N, Stickel F, Keogh A, Inderbitzin D, Candinas D, Pichler WJ. Fulminant liver failure after vancomycin in a sulfasalazine-induced DRESS syndrome fatal recurrence after liver transplantation. Am J Transplant 2009 9(9) 2197-202. 

Immunologic There have been further reports of drug rash with eosinophilia and systemic symptoms (DRESS) in patients taking sulfasalazine, a 47-year-old white Brazilian woman who developed DRESS after 8 weeks [104" ], a 60-year-old man with polyarthritis who also developed fulminant liver failure after additional vancomycin treatment [lOS ], and a 68-year-old woman in whom the reaction may have been precipitated by the addition of sulbactam -f ampicillin [lob ll. In another case, drug-induced hypersensitivity syndrome was associated with reactivation of an infection with human herpesvirus-6 in a 15-year-old boy with juvenile rheumatoid arthritis who was taking sulfasalazine [107 ]. 

An anaphylactic reaction was reported following 500 mg of oral vancomycin to treat severe Clostridium difficile infection. The patient was a 35-year-old posttransplant cystic fibrosis man who had several documented IgE reactions to antibiotics including cefepime, piperacillin as well as latex [81 ]. Five patients over a period of 4years at the Massachusetts General Hospital were reported to have developed DRESS syndrome in association with vancomycin use. Onset of symptoms varied from 12 days to 4 weeks after starting treatment and should be considered in subjects presenting late with typical findings [82 ]. 

Blumenthal KG, Patil SU, Long AA. The importance of vancomycin in drug rash with eosinophflia and systemic symptoms (DRESS) syndrome. Allergy Asthma Proc 2012 33(2) 165-71. 

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