Oxacillin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
| Autor: | Chase J Hardwick, Eric Bondarsky, Alexis Sharpe, Ezra Dweck, Bashar M Mourad, Theresa Reilly |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Drug-Related Side Effects and Adverse Reactions Epidural abscess 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine medicine Humans Eosinophilia Leukocytosis Oxacillin Leukopenia business.industry Articles General Medicine Middle Aged Staphylococcal Infections medicine.disease Rash Dermatology Anti-Bacterial Agents Drug Hypersensitivity Syndrome 030220 oncology & carcinogenesis Etiology Vancomycin medicine.symptom business Agranulocytosis medicine.drug |
| Zdroj: | The American Journal of Case Reports |
| ISSN: | 1941-5923 |
| Popis: | Patient: Male, 52 Final Diagnosis: Drug reaction with eosinophilia and systemic symptoms Symptoms: Rash Medication: Oxacillin Clinical Procedure: — Specialty: Critical Care Medicine Objective: Rare disease Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic life-threatening reaction comprised of fevers, rash, and leukocytosis with eosinophilia. Though characteristically associated with leukocytosis, there are rare case reports of DRESS-induced agranulocytosis. DRESS is most frequently caused by antiepileptic medications; however, it has very rarely been reported in relation to oxacillin. We describe a case of oxacillin-induced DRESS associated with agranulocytosis. Case Report: A 52-year-old male was admitted for an epidural abscess secondary to oxacillin-sensitive Staphylococcus aureus, for which an extended course of oxacillin and rifampin was initiated. On day 22 of therapy, the patient developed a fever of 38.7°C (101.6°F) with rigors. His complete blood cell count revealed new leukopenia (1.8×103/uL) with 16% eosinophils and 3% atypical lymphocytes. Antibiotics were transitioned from oxacillin and rifampin to vancomycin, cefepime, and rifampin for presumed sepsis of unclear etiology. On day 23, he was noted to have a pruritic erythematous blanching papular rash on his chest, trunk, neck, and left upper extremity. Infectious workup was unrevealing, and his fever curve up-trended to 39.3°C (102.7°F) with no clinical improvement on broad-spectrum antimicrobials, suggestive of a non-infectious etiology of his rash and fevers. His rash evolved into confluent red patches, and eosinophilia rose to 21%, which was concerning for a drug reaction. His RegiSCAR score was calculated to be 6, consistent with definite DRESS. Leukopenia resolved (6.3×103/uL) 4 days after discontinuing oxacillin. His epidural abscess was ultimately treated with daptomycin, and DRESS was managed supportively with antihistamines and triamcinolone cream. Conclusions: We highlight this case because of the rarity of DRESS with agranulocytosis related to oxacillin. Beta-lactam antibiotics are widely used, and while DRESS is an uncommon condition, clinicians should consider this diagnosis when managing patients with fevers, leukopenia, and rash. |
| Databáze: | OpenAIRE |
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