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Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection: A case report

RATIONALE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity reaction characterized by skin rash, fever, blood abnormalities, and multiple organ involvement. The diagnosis of DRESS syndrome is often delayed because of its variable presen...

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Autores principales: Wang, Li, Li, Lin-Feng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369923/
https://www.ncbi.nlm.nih.gov/pubmed/28296768
http://dx.doi.org/10.1097/MD.0000000000006346
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author Wang, Li
Li, Lin-Feng
author_facet Wang, Li
Li, Lin-Feng
author_sort Wang, Li
collection PubMed
description RATIONALE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity reaction characterized by skin rash, fever, blood abnormalities, and multiple organ involvement. The diagnosis of DRESS syndrome is often delayed because of its variable presentation. Prompt withdrawal of the culprit drug is the definitive treatment. DRESS syndrome induced by antituberculosis drugs has rarely been reported. PATIENT CONCERNS: A 50-year-old man admitted to our hospital with recurrent episodes of progressive rash, fever, eosinophilia, lymphadenopathy, hepatic, and pulmonary involvement were experienced after repeat trials of the same antituberculosis drugs. DIAGNOSES: We diagnosed it as DRESS caused by antituberculosis drugs. INTERVENTIONS: The case responded well to treatment with systemic corticosteroids and intravenous immunoglobulins. However, repeated bouts of infection with methicillin-resistant Staphylococcus aureus occurred during treatment (clavicular osteomyelitis and knee septic arthritis). He was cured after treatment with linezolid. OUTCOMES: The patient was discharged on day 112. At 8-month follow-up, there was no relapse of drug eruption and joint swelling. LESSONS: Early diagnosis and prompt withdrawal of all suspected drugs is a key tenet of the treatment of DRESS. Our case report highlights the risks inherent in delayed diagnosis of DRESS and the challenges in the clinical management of this condition. Pulmonary manifestations with radiological changes on chest X-ray and CT can be seen in DRESS. These changes need to be differentiated from those caused by pulmonary infections. Clavicular osteomyelitis infected with MRSA may be caused by iatrogenic injury during subclavian vein catheterization. This type of MRSA infections should be treated for 4 to 6 weeks. Blood eosinophilia could be a useful marker of disease progression and treatment response in patients with DRESS. However, more experience and clinical evidence is needed to confirm this.
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spelling pubmed-53699232017-03-31 Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection: A case report Wang, Li Li, Lin-Feng Medicine (Baltimore) 4000 RATIONALE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity reaction characterized by skin rash, fever, blood abnormalities, and multiple organ involvement. The diagnosis of DRESS syndrome is often delayed because of its variable presentation. Prompt withdrawal of the culprit drug is the definitive treatment. DRESS syndrome induced by antituberculosis drugs has rarely been reported. PATIENT CONCERNS: A 50-year-old man admitted to our hospital with recurrent episodes of progressive rash, fever, eosinophilia, lymphadenopathy, hepatic, and pulmonary involvement were experienced after repeat trials of the same antituberculosis drugs. DIAGNOSES: We diagnosed it as DRESS caused by antituberculosis drugs. INTERVENTIONS: The case responded well to treatment with systemic corticosteroids and intravenous immunoglobulins. However, repeated bouts of infection with methicillin-resistant Staphylococcus aureus occurred during treatment (clavicular osteomyelitis and knee septic arthritis). He was cured after treatment with linezolid. OUTCOMES: The patient was discharged on day 112. At 8-month follow-up, there was no relapse of drug eruption and joint swelling. LESSONS: Early diagnosis and prompt withdrawal of all suspected drugs is a key tenet of the treatment of DRESS. Our case report highlights the risks inherent in delayed diagnosis of DRESS and the challenges in the clinical management of this condition. Pulmonary manifestations with radiological changes on chest X-ray and CT can be seen in DRESS. These changes need to be differentiated from those caused by pulmonary infections. Clavicular osteomyelitis infected with MRSA may be caused by iatrogenic injury during subclavian vein catheterization. This type of MRSA infections should be treated for 4 to 6 weeks. Blood eosinophilia could be a useful marker of disease progression and treatment response in patients with DRESS. However, more experience and clinical evidence is needed to confirm this. Wolters Kluwer Health 2017-03-24 /pmc/articles/PMC5369923/ /pubmed/28296768 http://dx.doi.org/10.1097/MD.0000000000006346 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-sa/4.0 This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-sa/4.0
spellingShingle 4000
Wang, Li
Li, Lin-Feng
Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection: A case report
title Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection: A case report
title_full Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection: A case report
title_fullStr Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection: A case report
title_full_unstemmed Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection: A case report
title_short Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection: A case report
title_sort difficult clinical management of antituberculosis dress syndrome complicated by mrsa infection: a case report
topic 4000
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369923/
https://www.ncbi.nlm.nih.gov/pubmed/28296768
http://dx.doi.org/10.1097/MD.0000000000006346
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