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Hemodialysis treatment of vancomycin-induced drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome in a patient undergoing peritoneal dialysis

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Abstract

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.

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The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank the medical staff for their skillful care while treating this patient and Editage (www.editage.com) for English language editing.

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The authors have no financial sources to declare.

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Author notes

  1. Ryunosuke Mitsuno and Takashin Nakayama contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Ryunosuke Mitsuno, Takashin Nakayama, Kiyotaka Uchiyama, Norifumi Yoshimoto, Ei Kusahana, Jun Yoshino, Takeshi Kanda, Shintaro Yamaguchi & Kaori Hayashi

  2. Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Ryunosuke Mitsuno, Kohkichi Morimoto & Tadashi Yoshida

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  1. Ryunosuke Mitsuno
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Contributions

RM, TN and SY wrote the manuscript. RM, TN, KU, NY, EK, KM, TY, TK, SY, and KH took clinical care of the patient. JY and KH supervised the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Shintaro Yamaguchi.

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All the authors have declared no competing interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from the patient for publication of this case report and all accompanying images.

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Cite this article

Mitsuno, R., Nakayama, T., Uchiyama, K. et al. Hemodialysis treatment of vancomycin-induced drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome in a patient undergoing peritoneal dialysis. CEN Case Rep (2024). https://doi.org/10.1007/s13730-023-00847-x

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