Roy Sumon, Goswamy Vinay P, Barssoum Kirolos N, Rai Devesh
Department of Medicine, Rochester General Hospital, Rochester Regional Health System, Rochester, NY 14621, USA.
Case Reports Immunol. 2019 Apr 10;2019:1625010. doi: 10.1155/2019/1625010. eCollection 2019.
We present a unique case of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome masquerading as elusive endocarditis. A 37-year-old female actively using intravenous drugs presented with worsening right upper extremity pain, fever, and chills. Workup revealed methicillin-resistant staphylococcus aureus (MRSA) bacteremia and multiple right-sided septic pulmonary emboli. Echocardiogram was negative for vegetation. Vancomycin was initiated for bacteremia management suspected secondary to right upper extremity abscesses. However, despite resolution of abscesses, fevers persisted, raising suspicion for endocarditis not detected by echocardiogram. On hospital day 25, the patient began showing signs of DRESS syndrome, ultimately manifesting as transaminitis, eosinophilia, and a diffuse, maculopapular rash. Vancomycin was switched to Linezolid and she improved on high dose steroids. The persistent fevers throughout this hospital course were thought to be an elusive endocarditis before DRESS syndrome fully manifested. Although Vancomycin-induced DRESS is uncommon, this case highlights the importance of identifying early signs of significant adverse effects.
我们报告了一例独特的万古霉素诱发的伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）综合征，该综合征伪装成难以捉摸的心内膜炎。一名37岁的女性静脉吸毒者出现右上肢疼痛加剧、发热和寒战。检查发现耐甲氧西林金黄色葡萄球菌（MRSA）菌血症和多发性右侧脓毒性肺栓塞。超声心动图未发现赘生物。因怀疑继发于右上肢脓肿的菌血症，开始使用万古霉素进行治疗。然而，尽管脓肿消退，但发热持续存在，这引发了对超声心动图未检测到的心内膜炎的怀疑。在住院第25天，患者开始出现DRESS综合征的症状，最终表现为转氨酶升高、嗜酸性粒细胞增多和弥漫性斑丘疹。万古霉素换用利奈唑胺，患者在高剂量类固醇治疗下病情好转。在DRESS综合征完全显现之前，整个住院过程中持续的发热被认为是难以捉摸的心内膜炎。虽然万古霉素诱发的DRESS并不常见，但该病例凸显了识别严重不良反应早期迹象的重要性。
