(BMJ)—A 38-yo man w/ hx of hep C who’d been treated w/ vancomycin for osteomyelitis for the last 3wk presented w/ a 2-day hx of a generalized itchy rash. Exam: diffuse blanching red rash assoc w/ facial angioedema & axillary & inguinal adenopathy. Labs: elevated WBC count, elevated eosinophils, atypical lymphocytes, mildly elevated LFTs. What is the dx?
Leukocytoclastic vasculitis
DRESS syndrome
Acral necrolytic erythema
Angioimmunoblastic lymphadenopathy
Erythema multiforme major
You are correct. Drug reaction w/ eosinophilia and systemic symptoms (DRESS) syndrome was confirmed by bx and clinical criteria of enlarged lymph nodes, eosinophilia, atypical lymphocytes, rash ≥50% body surface area, and involvement of ≥1 internal organs (liver). DRESS syndrome is a rare but potentially life-threatening condition characterized by a delayed multisystem compromise after the administration of a drug. It most commonly occurs w/ anticonvulsants, but can also be secondary to other drugs, including vancomycin. In this pt, vanco was discontinued; he began daptomycin instead. He was also treated w/ high-dose antihistamines and steroids. Follow-up showed resolution of the rash.

BMJ Case Reports 2018;2018:bcr-2018-227378.