Hemodialysis treatment of vancomycin-induced drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome in a patient undergoing peritoneal dialysis.
Ryunosuke MitsunoTakashin NakayamaKiyotaka UchiyamaNorifumi YoshimotoEi KusahanaKohkichi MorimotoJun YoshinoTadashi YoshidaTakeshi KandaShintaro YamaguchiKaori HayashiPublished in: CEN case reports (2024)
Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DIHS), is a severe drug-induced hypersensitivity reaction with 10% mortality. To date, there is insufficient evidence regarding the association between DRESS/DIHS and serum levels of vancomycin (VCM). Here, we report the case of a 46-year-old woman undergoing peritoneal dialysis who developed VCM-induced DRESS/DIHS. She was hospitalized for peritonitis with abdominal pain and treated with VCM. On day 10 of hospitalization, her abdominal symptoms improved; however, fever, skin rash, lymphadenopathy, eosinophilia, atypical lymphocytes, and liver and renal dysfunction developed. Based on the clinical course and laboratory findings, we diagnosed the patient with DRESS/DIHS due to VCM. Since her serum VCM concentration was high at 39.8 μg/mL, hemodialysis (HD) was performed to remove VCM, which caused her symptoms to improve. However, serum levels of VCM rebounded and the same symptoms recurred. Therefore, we re-performed HD; no further relapse occurred. This clinical course showed that increased serum VCM levels were associated with DRESS/DIHS onset and severity, suggesting that it is a blood level-dependent disease and that removal of VCM by HD is a potential therapeutic option.
Keyphrases
- drug induced
- peritoneal dialysis
- liver injury
- end stage renal disease
- chronic kidney disease
- case report
- adverse drug
- oxidative stress
- methicillin resistant staphylococcus aureus
- emergency department
- type diabetes
- cardiovascular events
- coronary artery disease
- endothelial cells
- newly diagnosed
- diabetic rats
- staphylococcus aureus
- soft tissue
- free survival
- wound healing