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A Case of Vancomycin-Induced Drug Reaction with Eosinophilia, Systemic Symptoms and Multiorgan Involvement Proven Using Lymphocyte Transformation Test
Drug-induced hypersensitivity syndrome (DiHS), also referred to as drug reaction with eosinophilia and systemic symptoms (DRESS), is a rare but potentially life-threatening condition induced by drug hypersensitivity that leads to significant morbidity and mortality and often occurs in patients under...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Korean Dermatological Association; The Korean Society for Investigative Dermatology
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10112376/ https://www.ncbi.nlm.nih.gov/pubmed/37041708 http://dx.doi.org/10.5021/ad.20.341 |
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author | Chung, Kyung Bae Hwang, Ji-Hye Kim, Doyoung |
author_facet | Chung, Kyung Bae Hwang, Ji-Hye Kim, Doyoung |
author_sort | Chung, Kyung Bae |
collection | PubMed |
description | Drug-induced hypersensitivity syndrome (DiHS), also referred to as drug reaction with eosinophilia and systemic symptoms (DRESS), is a rare but potentially life-threatening condition induced by drug hypersensitivity that leads to significant morbidity and mortality and often occurs in patients undergoing combination antibiotic therapy. Due to a recent increase in the incidence of methicillin-resistant Staphylococcus aureus infections, the occurrence of vancomycin-induced DiHS/DRESS has increased rapidly. However, because of insufficient pharmacogenetic data on vancomycin-induced drug eruptions in Asians coupled with the risk of re-eliciting the symptoms by provocation tests, confirmation of the culprit drug in vancomycin-induced DiHS/DRESS is often challenging. Here, we report a case of vancomycin-induced DiHS/DRESS, where the causal relationship was confirmed using a lymphocyte transformation test (LTT). A 51-year-old woman was treated with combination antibiotics, including vancomycin, for infective pericarditis. The patient subsequently developed fever, facial edema, generalized rash followed by multiple internal organ involvement, including the kidney, lung, liver, and heart. Thus, based on the International Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) criteria, the case was diagnosed as ‘definite’ DiHS/DRESS, although the culprit drug was obscured by combination antibiotic therapy. The LTT confirmed that vancomycin, but not other glycopeptide antibiotics, specifically induced T-cell proliferation in this case. Collectively, our case suggests that clinicians can utilize LTT to identify the causative medication of DiHS/DRESS when the clinical information is limited to defining the culprit drug. |
format | Online Article Text |
id | pubmed-10112376 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | The Korean Dermatological Association; The Korean Society for Investigative Dermatology |
record_format | MEDLINE/PubMed |
spelling | pubmed-101123762023-04-19 A Case of Vancomycin-Induced Drug Reaction with Eosinophilia, Systemic Symptoms and Multiorgan Involvement Proven Using Lymphocyte Transformation Test Chung, Kyung Bae Hwang, Ji-Hye Kim, Doyoung Ann Dermatol Case Report Drug-induced hypersensitivity syndrome (DiHS), also referred to as drug reaction with eosinophilia and systemic symptoms (DRESS), is a rare but potentially life-threatening condition induced by drug hypersensitivity that leads to significant morbidity and mortality and often occurs in patients undergoing combination antibiotic therapy. Due to a recent increase in the incidence of methicillin-resistant Staphylococcus aureus infections, the occurrence of vancomycin-induced DiHS/DRESS has increased rapidly. However, because of insufficient pharmacogenetic data on vancomycin-induced drug eruptions in Asians coupled with the risk of re-eliciting the symptoms by provocation tests, confirmation of the culprit drug in vancomycin-induced DiHS/DRESS is often challenging. Here, we report a case of vancomycin-induced DiHS/DRESS, where the causal relationship was confirmed using a lymphocyte transformation test (LTT). A 51-year-old woman was treated with combination antibiotics, including vancomycin, for infective pericarditis. The patient subsequently developed fever, facial edema, generalized rash followed by multiple internal organ involvement, including the kidney, lung, liver, and heart. Thus, based on the International Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) criteria, the case was diagnosed as ‘definite’ DiHS/DRESS, although the culprit drug was obscured by combination antibiotic therapy. The LTT confirmed that vancomycin, but not other glycopeptide antibiotics, specifically induced T-cell proliferation in this case. Collectively, our case suggests that clinicians can utilize LTT to identify the causative medication of DiHS/DRESS when the clinical information is limited to defining the culprit drug. The Korean Dermatological Association; The Korean Society for Investigative Dermatology 2023-04 2023-03-09 /pmc/articles/PMC10112376/ /pubmed/37041708 http://dx.doi.org/10.5021/ad.20.341 Text en Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Chung, Kyung Bae Hwang, Ji-Hye Kim, Doyoung A Case of Vancomycin-Induced Drug Reaction with Eosinophilia, Systemic Symptoms and Multiorgan Involvement Proven Using Lymphocyte Transformation Test |
title | A Case of Vancomycin-Induced Drug Reaction with Eosinophilia,
Systemic Symptoms and Multiorgan Involvement Proven Using Lymphocyte
Transformation Test |
title_full | A Case of Vancomycin-Induced Drug Reaction with Eosinophilia,
Systemic Symptoms and Multiorgan Involvement Proven Using Lymphocyte
Transformation Test |
title_fullStr | A Case of Vancomycin-Induced Drug Reaction with Eosinophilia,
Systemic Symptoms and Multiorgan Involvement Proven Using Lymphocyte
Transformation Test |
title_full_unstemmed | A Case of Vancomycin-Induced Drug Reaction with Eosinophilia,
Systemic Symptoms and Multiorgan Involvement Proven Using Lymphocyte
Transformation Test |
title_short | A Case of Vancomycin-Induced Drug Reaction with Eosinophilia,
Systemic Symptoms and Multiorgan Involvement Proven Using Lymphocyte
Transformation Test |
title_sort | case of vancomycin-induced drug reaction with eosinophilia,
systemic symptoms and multiorgan involvement proven using lymphocyte
transformation test |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10112376/ https://www.ncbi.nlm.nih.gov/pubmed/37041708 http://dx.doi.org/10.5021/ad.20.341 |
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