Jafry Ali H, Nimri Jena, Akhtar Khawaja H, Qureshi Saleem, Bray-Hall Susan
Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Department of Rheumatology, Baylor College of Medicine, Houston, Texas, USA.
J Family Med Prim Care. 2022 Jul;11(7):3992-3995. doi: 10.4103/jfmpc.jfmpc_2073_21. Epub 2022 Jul 22.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity reaction carrying a mortality rate of up to 10%. We present a rare case of DRESS syndrome induced by amoxicillin-clavulanate, initially masquerading as red man syndrome. A 32-year-old male was admitted with flu-like symptoms and a maculopapular rash on the trunk and face that was exacerbated with vancomycin infusion, concerning for red man syndrome. He was receiving systemic antibiotics (vancomycin, ceftriaxone, and metronidazole) for infective endocarditis and previously took amoxicillin-clavulanate for a dental abscess. Despite the discontinuation of vancomycin, the exanthem continued to worsen, extending to involve >50% of his body surface area. Eosinophilia, hepatosplenomegaly, and acute kidney and liver injuries prompted consideration of DRESS syndrome. All antibiotics were discontinued, and systemic glucocorticoids were initiated. Punch biopsy revealed interface dermatitis with eosinophilic infiltrates; a high RegiSCAR score confirmed the diagnosis of DRESS. Amoxicillin-clavulanate was flagged as a severe allergy and deemed the culprit owing to the timing of exposure and personal/family history of hypersensitivity.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征是一种严重的药物诱导的超敏反应，死亡率高达10%。我们报告一例由阿莫西林-克拉维酸诱导的罕见DRESS综合征病例，最初表现为红人综合征。一名32岁男性因类似流感症状入院，躯干和面部出现斑丘疹，万古霉素输注后加重，怀疑为红人综合征。他因感染性心内膜炎正在接受全身抗生素治疗（万古霉素、头孢曲松和甲硝唑），之前因牙脓肿服用过阿莫西林-克拉维酸。尽管停用了万古霉素，但皮疹仍继续恶化，累及身体表面积超过50%。嗜酸性粒细胞增多、肝脾肿大以及急性肾和肝损伤促使考虑DRESS综合征。停用所有抗生素，并开始使用全身糖皮质激素。皮肤活检显示界面性皮炎伴嗜酸性粒细胞浸润；高RegiSCAR评分确诊为DRESS。由于接触时间以及个人/家族过敏史，阿莫西林-克拉维酸被标记为严重过敏并被认定为罪魁祸首。
