DRESS with delayed onset acute interstitial nephritis and profound refractory eosinophilia secondary to Vancomycin.docVIP

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DRESS with delayed onset acute interstitial nephritis and profound refractory eosinophilia secondary to Vancomycin.doc

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DRESS with delayed onset acute interstitial nephritis and profound refractory eosinophilia secondary to Vancomycin

O’Mearaetal.Allergy,AsthmaClinicalImmunology2011,7:16 /content/7/1/16 ALLERGY, ASTHMA CLINICAL IMMUNOLOGY CASE REPORT OpenAccess DRESSwithdelayedonsetacuteinterstitial nephritisandprofoundrefractoryeosinophilia secondarytoVancomycin PalomaO’Meara1,RozitaBorici-Mazi1,ARossMorton1andAnneKEllis1,2* Abstract Background:DrugReactionwithEosinophiliaandSystemicSymptoms(DRESS)isarelativelyrareclinicalentity; evenmoresoinresponsetovancomycin. Methods:Casereport. Results:Wepresentaseverecaseofvancomycin-inducedDRESSsyndrome,whichonpresentationincludedonly skin,hematologicalandmildliverinvolvement.Thepatientfurtherdevelopedsevereacuteinterstitialnephritis, eosinophilicpneumonitis,centralnervoussystem(CNS)involvementandworseninghematologicalabnormalities despiteimmediatediscontinuationofvancomycinandparenteralcorticosteroids.High-dosecorticosteroidsfora prolongedperiodwerenecessaryandtaperingofsteroidsachallengeduetorebound-eosinophiliaandskin involvement. Conclusion:PatientswithDRESSwhoarerelativelyresistanttocorticosteroidswithdelayedonsetofcertainorgan involvementshouldbetreatedwithamoreprolongedcorticosteroidtaperingschedule.Vancomycinisincreasingly beingrecognizedasaculpritagentinthissyndrome. Introduction vancomycinwasinitiated.Afterfourweeksofvancomy- WepresentacaseofsevereDrugReactionwithEosino- cin therapy he developed a rash. This was initially philia and Systemic Symptoms (DRESS) [1] syndrome thoughttobeduetoared-mansyndromevariant.Infu- secondary to vancomycin, with associated multiorgan sionrateswereslowed,andpremedicationwithdiphen- dysfunction. The relatively high mortality of this syn- hydramine was initiated, but the rash worsened, with dromewarrants prompt recognition andelimination of the subsequent development of episodic daily fevers, the culprit drug and often treatment with high-dose documentedtobeashighas40°C. corticosteroids. Hispastmedicalhistory wassignificant forheterozy- goushemochromatosis,aremotesplenectomysecondary to traumatic rupt