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The patient further developed severe acute interstitial nephritis, eosinophilic pneumonitis, central nervous system (CNS) involvement and worsening hematological abnormalities despite immediate discontinuation of vancomycin and parenteral corticosteroids. High-dose corticosteroids for a prolonged period were necessary and tapering of steroids a challenge due to rebound-eosinophilia and skin involvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with DRESS who are relatively resistant to corticosteroids with delayed onset of certain organ involvement should be treated with a more prolonged corticosteroid tapering schedule. Vancomycin is increasingly being recognized as a culprit agent in this syndrome.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1710-1492-7-16","type":"journal-article","created":{"date-parts":[[2011,10,22]],"date-time":"2011-10-22T18:21:38Z","timestamp":1319307698000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["DRESS with delayed onset acute interstitial nephritis and profound refractory eosinophilia secondary to Vancomycin"],"prefix":"10.1186","volume":"7","author":[{"given":"Paloma","family":"O'Meara","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rozita","family":"Borici-Mazi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A Ross","family":"Morton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne K","family":"Ellis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2011,10,3]]},"reference":[{"issue":"1","key":"252_CR1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1111\/j.1365-2230.2010.03967.x","volume":"36","author":"SA Walsh","year":"2011","unstructured":"Walsh SA, Creamer D: Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. 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