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.