Department of Internal Medicine, Michigan State University, East Lansing, MI, USA.
Pulmonary Critical Care, Sparrow Medical Group, Lansing, MI, USA.
BMC Pulm Med. 2017 Dec 28;17(1):217. doi: 10.1186/s12890-017-0564-6.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity drug reaction involving the skin and multiple internal organ systems. The symptoms typically present with fever and skin rash, and rapidly progress to multiple organ failures. Vancomycin is a rare drug to cause DRESS syndrome with 23 cases reported to date.
We described a case of a 39 year-old man who was treated with vancomycin for osteomyelitis of the foot. The patient subsequently developed acute respiratory distress syndrome (ARDS) followed by rash and acute interstitial nephritis. These symptoms were improved by withdrawal of vancomycin and a pulsed corticosteroid regimen. According to the European Registry of Severe Cutaneous Adverse Reaction Criteria (RegiSCAR) (Kardaun et al, British Journal of Dermatology, 169:1071-1080, 2013), the probability of vancomycin induced DRESS syndrome was scored as "Definite". A literature search of vancomycin induced DRESS syndrome was also performed and the overall pulmonary involvement was estimated as 5%. To our knowledge, this was the first case reported with pulmonary involvement as the initial symptom.
This is the first case to report pulmonary manifestation as the initial symptom in vancomycin induced DRESS syndrome. Prompt recognition of this entity can expedite proper treatment and hasten recovery.
药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种严重的过敏药物反应，涉及皮肤和多个内脏器官系统。其症状通常表现为发热和皮疹，并迅速发展为多器官衰竭。迄今为止，已有 23 例报告称万古霉素可引起 DRESS 综合征，是一种罕见的引起该综合征的药物。
我们描述了一例 39 岁男性，因足部骨髓炎接受万古霉素治疗。随后，患者出现急性呼吸窘迫综合征（ARDS），继而出现皮疹和急性间质性肾炎。停用万古霉素和采用脉冲皮质类固醇方案后，这些症状得到改善。根据欧洲严重皮肤不良反应登记（RegiSCAR）标准（Kardaun 等人，《英国皮肤病学杂志》，169:1071-1080，2013），将万古霉素引起的 DRESS 综合征的可能性评分为“明确”。还对万古霉素引起的 DRESS 综合征进行了文献检索，总体肺部受累估计为 5%。据我们所知，这是首例报告以肺部受累为首发症状的病例。
这是首例报告以肺部表现为万古霉素诱导的 DRESS 综合征首发症状的病例。及时认识到这一实体可以加速适当的治疗并促进康复。
