A Case of Vancomycin-Induced Drug Reaction with Eosinophilia, Systemic Symptoms and Multiorgan Involvement Proven Using Lymphocyte Transformation Test
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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 Tcell 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.
Abstract
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 Tcell 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.
참고문헌 (20)
- Cabañas R, "Sensitivity and specificity of the lymphocyte transformation test in drug reaction with eosinophilia and systemic symptoms causality assessment", Clin Exp Allergy, 48, pp.325~333 (2018)
- Shiohara T, "Drug-induced hypersensitivity syndrome(DiHS)", drug reaction with eosinophilia and systemic symptoms(DRESS) : an update in 2019, 2019, pp.68, 301~308
- Demoly P, "International Consensus on drug allergy", Allergy, 69, pp.420~437 (2014)
- Kim D, "Targeted therapy guided by single-cell transcriptomic analysis in drug-induced hypersensitivity syndrome : a case report", Nat Med, 26, pp.236~243 (2020)
- Kim MN, "Vancomycinintermediate Staphylococcus aureus in Korea", J Clin Microbiol, 38, pp.3879~3881 (2000)
- Zafar S, "Vancomycininduced DRESS syndrome", Ann Allergy Asthma Immunol, 124, pp.107~108 (2020)
- Cho YT, "Drug Reaction with Eosinophilia and Systemic Symptoms(DRESS) : an interplay among drugs, viruses, and immune system", Int J Mol Sci, 18, pp.1243~ (2017)
- Nakkam N, "Cross-reactivity between vancomycin, teicoplanin, and telavancin in patients with HLA-A*32 : 01-positive vancomycininduced DRESS sharing an HLA class II haplotype", J Allergy Clin Immunol, 147, pp.403~405 (2021)
- Miyazu D, "DRESS syndrome caused by cross-reactivity between vancomycin and subsequent teicoplanin administration : a case report", Am J Case Rep, 17, pp.625~631 (2016)
- Thongsri T, "Cardiac involvement in DRESS syndrome", Asian Pac J Allergy Immunol, 35, pp.3~10 (2017)
- Wilcox O, "Case report : atypical presentation of vancomycin induced DRESS syndrome : a case report and review of the literature", BMC Pulm Med, 17, pp.217~ (2017)
- Díaz-Mancebo R, "Dress syndrome and acute tubulointerstitial nephritis after treatment with vancomycin and betalactams. Case report and literature review", Nefrologia, 32, pp.685~687 (2012)
- Madigan LM, "Vancomycin-associated drug-induced hypersensitivity syndrome", J Am Acad Dermatol, 81, pp.123~128 (2019)
- Mennicke M, "Fulminant liver failure after vancomycin in a sulfasalazine-induced DRESS syndrome : fatal recurrence after liver transplantation", Am J Transplant, 9, pp.2197~2202 (2009)
- Gangireddy M, "A fatal case of vancomycin associated drug reaction with eosinophilia and systemic symptoms syndrome in a septuagenarian", Cureus, 11, pp.e5015~ (2019)
- Konvinse KC, "HLA-A*32 : 01 is strongly associated with vancomycininduced drug reaction with eosinophilia and systemic symptoms", J Allergy Clin Immunol, 144, pp.183~192 (2019)
- Lochmatter P, "In vitro tests in drug hypersensitivity diagnosis", Immunol Allergy Clin North Am, 29, pp.537~554 (2009)
- Mayorga C, "In vitro tests for drug hypersensitivity reactions : an ENDA", EAACI Drug Allergy Interest Group position paper, 2016, pp.71, 1103~1134
- Galbiati V, "In vitro models to evaluate drug-induced hypersensitivity : potential test based on activation of dendritic cells", Front Pharmacol, 7, pp.204~ (2016)
- Schrijvers R, "Pathogenesis and diagnosis of delayed-type drug hypersensitivity reactions, from bedside to bench and back", Clin Transl Allergy, 5, pp.31~ (2015)