{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T23:01:39Z","timestamp":1774393299707,"version":"3.50.1"},"reference-count":14,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,8,30]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:p>A 57-year-old man presented for an elective pacemaker upgrade, complicated by the discovery of device infection. He had a background of complex congenital heart disease, including replacement of heart valves, and was treated for presumed infective endocarditis that was later confirmed by echocardiography. Antibiotic treatment, with intravenous vancomycin, was given as per the tissue sample sensitivities. On day 24 of treatment he deteriorated clinically, with the evolution of recurrent fever, epigastric pain, diarrhoea, widespread pruritic rash, lymphadenopathy and severe hypoxia over the subsequent 7\u201310 days. Blood tests revealed development of a marked eosinophilia, transaminitis and rising inflammatory markers. Further radiological imaging was non-diagnostic. On the basis of these clinical and biochemical features a diagnosis of drug reaction with eosinophilia and systemic symptoms syndrome was made. This led to the cessation of vancomycin, the offending agent and the referral for specialist immunology advice. He was subsequently treated with oral prednisolone and made a full recovery.<\/jats:p>","DOI":"10.1136\/bcr-2019-229590","type":"journal-article","created":{"date-parts":[[2019,9,16]],"date-time":"2019-09-16T21:10:21Z","timestamp":1568668221000},"page":"e229590","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Vancomycin induced DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) in a patient with tricuspid endocarditis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3361-0713","authenticated-orcid":false,"given":"Lynsey Jane","family":"Hewitson","sequence":"first","affiliation":[{"name":"Medicine, Bristol Royal Infirmary, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,9,16]]},"reference":[{"key":"2025082703232441000_12.9.e229590.1","unstructured":"Waseem D , Latief M , Sofi N , et al . Dress syndrome: a review and update. Skin Dis Skin Care 2016;1."},{"key":"2025082703232441000_12.9.e229590.2","unstructured":"Roujeau J-C . UpToDate. Drug reaction with eosinophilia and systemic symptoms (DRESS). 2013 https:\/\/www.uptodate.com\/contents\/drug-reaction-with-eosinophilia-and-systemic-symptoms-dress (cited 1 Oct 2018)."},{"key":"2025082703232441000_12.9.e229590.3","unstructured":"NICE. Clinical guideline [CG183]. Drug allergy: diagnosis and management.\u00a0NICE guidelines. 2014 https:\/\/www.nice.org.uk\/guidance\/cg183 (cited 1 Oct 2018)."},{"key":"2025082703232441000_12.9.e229590.4","doi-asserted-by":"crossref","first-page":"693.e1-","DOI":"10.1016\/j.jaad.2013.01.033","article-title":"DRESS syndrome: Part 1. Clinical perspectives","volume":"68","author":"Husain","year":"2013","journal-title":"J Am Acad Dermatol"},{"key":"2025082703232441000_12.9.e229590.5","first-page":"31","article-title":"Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome","volume":"6","author":"Choudhary","year":"2013","journal-title":"J Clin Aesthet Dermatol"},{"key":"2025082703232441000_12.9.e229590.6","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1001\/archdermatol.2012.1079","article-title":"Initial presentation of DRESS: often misdiagnosed as infections","volume":"148","author":"Lee","year":"2012","journal-title":"Arch Dermatol"},{"key":"2025082703232441000_12.9.e229590.7","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-007-8010-9"},{"key":"2025082703232441000_12.9.e229590.8","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1080\/17425255.2017.1297422","article-title":"Prediction and management of drug reaction with eosinophilia and systemic symptoms (DRESS)","volume":"13","author":"Shiohara","year":"2017","journal-title":"Expert Opin Drug Metab Toxicol"},{"key":"2025082703232441000_12.9.e229590.9","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1159\/000448284","article-title":"Evaluation of lymphocyte transformation test results in patients with delayed hypersensitivity reactions following the use of anticonvulsant drugs","volume":"170","author":"Karami","year":"2016","journal-title":"Int Arch Allergy Immunol"},{"key":"2025082703232441000_12.9.e229590.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2222.1997.tb00690.x"},{"key":"2025082703232441000_12.9.e229590.11","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.mayocp.2016.03.006","article-title":"Management of Psychotropic Drug-Induced DRESS Syndrome: a systematic review","volume":"91","author":"Bommersbach","year":"2016","journal-title":"Mayo Clin Proc"},{"key":"2025082703232441000_12.9.e229590.12","first-page":"139","article-title":"Drug reaction with eosinophilia and systemic symptoms (DRESS): incidence, pathogenesis and management","volume":"16","author":"Shiohara","year":"2017","journal-title":"Expert Opin Drug Saf"},{"key":"2025082703232441000_12.9.e229590.13","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.3390\/ijms18061243","article-title":"Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): an interplay among drugs, viruses, and immune system","volume":"18","author":"Cho","year":"2017","journal-title":"Int J Mol Sci"},{"key":"2025082703232441000_12.9.e229590.14","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.jaad.2018.08.052","article-title":"Drug-induced hypersensitivity syndrome\/drug reaction with eosinophilia and systemic symptoms severity score: A useful tool for assessing disease severity and predicting fatal cytomegalovirus disease","volume":"80","author":"Mizukawa","year":"2019","journal-title":"J Am Acad Dermatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-229590","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:23:33Z","timestamp":1756290213000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-229590"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":14,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,9,16]]},"published-print":{"date-parts":[[2019,9]]}},"alternative-id":["10.1136\/bcr-2019-229590"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-229590","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]}}}