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DRESS syndrome presenting after initiation of mycobacterium avium complex osteomyelitis treatment

Paul W Blair1, Douglas Herrin1, Nawaf Abaalkhail1

  • 1School of Medicine and Health Sciences, George Washington University, Washington DC, USA.

BMJ Case Reports
|October 7, 2015
PubMed

Insights

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) is a severe reaction to medication. This case shows DRESS developing from MAC vertebral osteomyelitis treatment, highlighting complex management needs.

Area of Science:

  • Pharmacovigilance
  • Infectious Diseases
  • Dermatology

Background:

  • Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe, idiosyncratic drug reaction.
  • It typically manifests 2-6 weeks post-medication initiation with fever, rash, eosinophilia, and organ damage.
  • Mycobacterium avium complex (MAC) vertebral osteomyelitis requires multi-drug therapy, often including ethambutol, clarithromycin, and rifabutin.

Observation:

  • A 79-year-old male developed DRESS syndrome.
  • The reaction occurred after initiating treatment for MAC vertebral osteomyelitis with rifabutin, ethambutol, and clarithromycin.
  • The patient required prolonged corticosteroid therapy for DRESS management.

Findings:

  • This case illustrates a rare presentation of DRESS syndrome linked to MAC treatment.
  • Management was complicated by the need for prolonged steroids in a patient with a concurrent infection.
  • Multidisciplinary collaboration is crucial for managing DRESS in patients with co-existing infections.

Implications:

  • Highlights the importance of recognizing DRESS syndrome in patients treated for MAC vertebral osteomyelitis.
  • Emphasizes the challenges of steroid management in DRESS patients with concomitant infections.
  • Underscores the need for a collaborative approach involving infectious disease specialists, dermatologists, and pharmacists for optimal patient outcomes.

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