Vancomycin-induced DRESS syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially life-threatening drug-induced hypersensitivity reaction. Vancomycin accounts for approximately two thirds of DRESS cases caused by antibiotics. 1 Lam B. Miller M. Sutton A. et al. Vancomycin and DRESS: a retrospective chart review of 32 cases in Los Angeles, California. J Am Acad Dermatol. 2017; 77: 973-975 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar This is important to recognize in light of increasing use of vancomycin; a review of antimicrobial usage in acute care hospitals in the United States reports vancomycin as the most commonly used antimicrobial. 2 Magill S.S. Edwards J.R. Beldavs Z.G. et al. Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team: Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA. 2014; 312: 1438-1446 Crossref PubMed Scopus (245) Google Scholar The following case series describes 2 cases of DRESS associated with vancomycin in our institution (Table 1). Table 1RegiSCAR Scoring for DRESS Syndrome 3 Roujeau J.C. Allanore L. Liss Y. Mockenhaupt M. Severe cutaneous adverse reactions to drugs (SCAR): definitions, diagnostic criteria, genetic predisposition. Dermatol Sinica. 2009; 27: 203-209 Google Scholar RegiSCAR group study criteria No Yes Unknown Fever ≥ 38.5°C -1 0 1 Enlarged lymph nodes (≥2 sites, >1 cm) 0 1 0 Atypical lymphocytes 0 1 0 Eosinophilia 0 0 700-1,499 or 10%-19.9% 1 ≥1,500 or ≥20% 2 Skin rash 0 0 Extent >50% 0 1 0 At least 2 of: edema, infiltration, purpura, scaling -1 1 0 Biopsy suggestive of DRESS -1 0 0 Internal organ involved 0 0 1 1 ≥2 2 Resolution in >15 days -1 0 1 ≥3 negative biological investigations to exclude alternative diagnosis 0 1 0 Open table in a new tab