When fever is more than infection: two cases of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS)

2021 ◽  
Vol 14 (1) ◽  
pp. e238006
Author(s):  
Mitchell Cox ◽  
Sophie Paviour ◽  
Sophie Gregory ◽  
Rusheng Chew
Keyword(s):  
Drug Reaction ◽  
Cytomegalovirus Reactivation ◽  
First Case ◽  
Metropolitan Hospital ◽  
Orthopaedic Ward ◽  
Systemic Hypersensitivity ◽  
Systemic Symptoms ◽  
Inflammatory Syndrome ◽  
Intravenous Glucocorticoids

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but serious systemic hypersensitivity reaction associated with a range of medications. We present two cases of vancomycin-induced DRESS, which occurred simultaneously in the orthopaedic ward in an outer metropolitan hospital. These cases demonstrate the complexity in the diagnosis and management of this inflammatory syndrome on the background of known infection as well as evidence for linezolid as an alternative to vancomycin. The first case was managed conservatively, but developed progressive renal and liver injury along with demonstrated cytomegalovirus reactivation and recurrent colitis, and was eventually palliated. The second was commenced on intravenous glucocorticoids and achieved remission, although had ongoing renal dysfunction at the time of discharge from outpatient follow-up.

scholarly journals Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide

2017 ◽  
Vol 52 (6) ◽  
pp. 408-411 ◽  
Author(s):  
Anusha Shanbhag ◽  
E. Ryan Pritchard ◽  
Kshitij Chatterjee ◽  
Drayton A. Hammond
Keyword(s):  
Drug Reaction ◽  
Hemodynamic Instability ◽  
African American Female ◽  
Probability Scale ◽  
Blood Cell Count ◽  
Dress Syndrome ◽  
Peripheral Smear ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening hypersensitivity reaction to medications. We report a case of a 75-year-old African American female who presented with generalized rash with desquamation and malodorous secretions. She was febrile and hypotensive, and required vasopressors for hemodynamic instability. Sepsis secondary to skin or soft tissue infection was considered initially. However, she recently was started on lenalidomide for treatment of her multiple myeloma, and her white blood cell count of 17 K/µL with 55% eosinophils along with peripheral smear showing eosinophilia suggested lenalidomide-induced rash. Lenalidomide was discontinued, and methylprednisolone was initiated. Four days after lenalidomide discontinuation, vasopressors were discontinued. Blood cultures did not exhibit any growth. The Niranjo Adverse Drug Reaction Probability Scale score of 9 suggests lenalidomide was a highly probable cause of DRESS syndrome. The temporal relation of lenalidomide administration and development of symptoms plus improvement of rash with the discontinuation of lenalidomide and reappearance on restarting lenalidomide in the follow-up clinic strengthens our suspicion of lenalidomide-induced DRESS syndrome. Cases of lenalidomide-induced DRESS syndrome are sparse; however, DRESS syndrome is fatal in approximately 10% of patients. Providers should be aware and keep a vigilant eye out for this adverse reaction with lenalidomide.

scholarly journals A Mysterious DRESS Case: Autoimmune Enteropathy Associated with DRESS Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Abimbola Adike ◽  
Vaishnavi Boppana ◽  
Dora Lam-Himlin ◽  
Melissa Stanton ◽  
Steven Nelson ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Gastrointestinal Tract ◽  
Case Description ◽  
Gastrointestinal Involvement ◽  
Dress Syndrome ◽  
Autoimmune Enteropathy ◽  
First Case ◽  
Cutaneous Hypersensitivity ◽  
Life Threatening ◽  
Systemic Symptoms

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare but potentially life-threatening cutaneous hypersensitivity reaction characterized by extensive mucocutaneous eruption, fever, hematologic abnormalities, and extensive organ involvement. Here, we present a case of a young woman with DRESS syndrome following exposure to vancomycin with renal, cutaneous, and gastrointestinal involvement. To the best of our knowledge, this is the first case description in the literature of DRESS of the gastrointestinal tract with autoimmune enteropathy.

scholarly journals First case of DRESS (drug reaction with eosinophilia and systemic symptoms) associated with Voxelotor

2021 ◽  
Author(s):  
Matthew Lee ◽  
Thomas Stringer ◽  
Jack Jacob ◽  
Elana M. Friedman ◽  
Caterina Minniti ◽  
...  
Keyword(s):  
Drug Reaction ◽  
First Case ◽  
Systemic Symptoms

scholarly journals A Rare Presentation of Clozapine-Induced DRESS Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Carmel Moazez ◽  
Yasir Rudha ◽  
Natasha Narang ◽  
Tina Younger
Keyword(s):  
Bipolar Disorder ◽  
Drug Reaction ◽  
Side Effect ◽  
Organ Involvement ◽  
Past Medical History ◽  
Dress Syndrome ◽  
Rare Presentation ◽  
First Case ◽  
The Common ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is an uncommon side effect of certain medications. It causes a skin reaction, with eosinophilia and other organ involvement. This case describes a presentation of a 32-year-old female with a past medical history significant for schizophrenia and bipolar disorder who presented for a rash. She had been started on clozapine 10 days prior to admission. After extensive workup she was found to have DRESS syndrome secondary to clozapine use. This is the second reported case in the literature of clozapine-induced DRESS syndrome. This case is unique because it is the first case to present with the common manifestations of DRESS syndrome including eosinophilia, rash, lymphadenopathy, and organ involvement after clozapine use.

scholarly journals Suspected Agomelatine-induced restless legs syndrome: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mustafa Abdul Karim ◽  
Nadeen Al-Baz ◽  
Sami Ouanes ◽  
Majid Alabdulla ◽  
Peter M. Haddad
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Case Report ◽  
Restless Legs Syndrome ◽  
Lower Limbs ◽  
Complete Relief ◽  
Restless Legs ◽  
First Case ◽  
Primary Disorder

Abstract Background Restless Legs Syndrome (RLS) is a sensorimotor disorder characterized by unpleasant and distressing sensations in the lower limbs that are more pronounced in the evening, commence or worsen at rest, and show partial or complete relief following movement. It can occur as a primary disorder, secondary to medical conditions or treatment with medications including but not limited to antidepressants or antipsychotics. Case presentation A 32-year old man with major depressive disorder showed partial response to Escitalopram 10 mg daily. Agomelatine 25 mg at night was added to Escitalopram to treat his residual depressive symptoms, namely insomnia and tiredness. Within two days he developed restlessness and unpleasant sensations in his legs which were worse at night. Symptom severity increased over the following days, prompting an urgent consultation a week later. The patient’s presentation met the criteria for RLS. Agomelatine was discontinued leaving the patient on Escitalopram alone. The patient’s symptoms improved within 24 h of stopping Agomelatine, with complete resolution four days later. There was no recurrence of RLS during follow-up. The patient scored 6 on Naranjo’s adverse drug reaction probability scale, indicating a probable adverse drug reaction caused by Agomelatine. Conclusions To the best of our knowledge, this is the first case report of suspected Agomelatine-induced RLS. Clinicians need to be aware of RLS to enable prompt diagnosis and management. We suggest adding Agomelatine to the list of agents that can potentially induce RLS.

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