Table 3.
Clinical data for cases of Drug Rash Eosinophilia and Systemic Symptoms (DRESS) syndrome to vancomycin (n=16)
| Age (yrs) |
Gender (m/f) |
Infection treated | Reaction timing* |
Clinical signs and symptoms |
Laboratory findings |
Treatment | Outcome | |
|---|---|---|---|---|---|---|---|---|
| Young et al. 2014 |
24 | M |
Corynebacterium
jeikeium septic arthritis |
21d | MP rash, arthralgia, lymphadenopathy, fever |
AEC: 2,900/L AST M/ALT 270mg/dL No nephritis RegiSCAR score 7 |
IV steroids with a prednisone taper |
Clinically improved with resolution of symptoms |
| Young et al 2014 |
48 | F | L5/S1 osteomyelitis |
14d | MP rash, facial edema, odynophagia, fever, chills |
AEC: 2,200/L AST M/ALT 337mg/dL No nephritis RegiSCAR score 6 |
IV steroids with prolonged prednisone taper |
Clinically improved within 5 days |
| Young et al. 2014 |
59 | F | MRSA wound infection |
21d | MP rash, fever and facial edema |
AEC: 10,400/L AST M/ALT 113mg/dL No nephritis RegiSCAR score 6 |
Oral and topical steroids Antihistamines |
Clinically improved |
| Della-Torre et al. 2013 |
75 | M | Culture negative endocarditis |
27d | MP rash, fever | AEC: 0.6 × 109 AST 45/ALT 264mg/dL Cr. (bl M, max 1.31mg/dL) RegiSCAR score > 7 |
IV steroids Antihistamines IVIG |
Clinically improved, labs normalized |
| Blumenthal et al. 2013 |
65 | M | β-hemolytic Streptococcus group B empyema |
12d | MP rash | AEC: 3460/L AST 440mg/dL/AL T 105mg/dL Cr. (bl 0.5, max 2.1mg/dL) Atypical lymphocytes: none |
IV Steroids | Clinical improvement within 48h DRESS resolved after 2 months |
| Blumenthal et al. 2013 |
40 | M |
Propionibacterium
and Peptostreptococcus prosthetic joint infection |
28d | MP rash, fever, cervical lymphadenopathy, splenomegaly, pitting edema |
AEC:3,890/L AST 178mg/dL/AL T 122mg/dL Cr (bl 0.8mg/dL,max 2.2mg/dL) HHV6 IgG <1:20 |
IV steroids, followed by 6 month oral taper |
Clinical improvement within 2 days |
| Blumenthal et al. 2013 |
48 | F | Coagulase negative S.aureus prosthetic joint infection |
28d | MP rash, fever | AEC:1,900/L AST 85mg/dL/ALT 137mg/dL No nephritis HHV6 <1:20 |
No steroids used in management Antihistamines |
Gradual clinical improvement with supportive care |
| Blumenthal et al. 2013 |
74 | M | Gram positive cocci cellulitis after traumatic hand injury |
21d | MP rash, fever, facial and peripheral edema, hypotension, tachycardia |
AEC: 6,550/L AST 75mg/dL/ALT 170mg/dL Cr (bl 1.4 mg/dL,max 2.3mg/dL) HHV6 <1:20 |
No steroids used in management IVF Switched therapy |
Clinically improved |
| Blumenthal et al. 2013 |
51 | M | Osteomyelitis | 21d | MP rash, periorbital edema, chest tightness, nausea, fever, chills, lightheadedness |
AEC: 1,620/L AST 107 mg/dL/ALT 347mg/dL No nephritis HHV6 DNA <600 |
IV steroids Switched therapy |
Clinically improved |
| Dauby et al. 2012 |
54 | F | Methicillin- resistant Staphylococcus epidermis catheter associated bacteremia (febrile neutropenia in setting of chemotherapy for breast cancer) |
7d | MP rash, fever, chills |
AEC: 6,380/L AST 31mg/dL /ALT 45 mg/dL No nephritis |
Topical steroids Antihistamines Antipyretic Switched therapy |
Clinically improved |
| O’Meara et al. 2011 |
66 | M | ORIF c/b MRSA | 28d | MP rash, fever, facial edema, lymphadenopathy |
AEC: 3,620/L AST 163mg/dL /ALT 144mg/dL Cr (bl 1.3mg/dL,max 4.9mg/dL) |
IV steroids | Clinically improved after prolonged treatment course |
| Boet et al. 2009 |
38 | F |
Streptococcus
oralis endocarditis |
30d | MP rash, fever, facial edema |
AEC: 2820/L No nephritis |
IV steroids | Clinically improved, discharged within few weeks |
| Vauthey et al. 2008 |
60 | F | MRSA cellulitis after amputation |
18d | MP rash, fever, periorbital edema |
AEC: 1,251/L Cr Cl 30mL/min |
IV steroids Topical steroids Antihistamines |
Gradually improved, discharged after 2 months |
| Tamagawa- Mineoka et al. 2007 |
52 | M | Cholesteatoma s/p tymanoplasty (MRSA infection from ear wound) |
4d | MP rash, fever, facial edema |
AEC: 1,832/L AST 358 mg/dL/ALT 547mg/dL Cr (bl NA, max 3.58 mg/dL) HHV6 DNA 1:320 |
IV steroids followed by prednisone taper |
Clinically resolved |
| Zuliani et al. 2005 |
45 | F | Coagulase negative endocarditis |
18d | MP rash, fever, facial edema |
AEC: 1,474/L AST 385 mg/dL/ALT 599 mg/dL Cr (bl 0.8 mg/dL,max 5.3 mg/dL) |
IV steroids with prednisone taper Antihistamines Hemodialysis Cyclosporine |
After two cutaneous relapses, Clinically improved |
| Marik et al. 1997 |
51 | M | Culture negative endocarditis |
30d | MP rash, palpitations, malaise, dyspnea and rigors |
AEC: 5,875/L Cr (bl 1.0 mg/dL, max 7.8 mg/dL) |
IV steroids | Clinically improved in 1 week. Hospital course c/b urosepsis |
*
Timing from vancomycin dose to reaction onset
Abbreviations: d: days; MP: maculopapular; AEC: absolute neutrophil count; M: missing; RegiSCAR: registry of severe cutaneous adverse reactions; IV: intravenous; MRSA: methicillin-resistant Staphylococcus aureus; Cr: creatinine; bl: baseline; IVIG: intravenous immunoglobins; DRESS: drug rash eosinophilia with systemic symptoms; HHV6: human herpesvirus 6; IVF: intravenous fluids; ORIF: open reduction internal fixation; c/b: complicated by; Cl: clearance;