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Drug Reaction with Eosinophilia and Systemic Symptoms Following Antibiotic Cement Spacer Placement: A Case Report
Jonathan C Arnold1, Elliot Druten1, Rachel Kowal2
1Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Case:
A 44-year-old woman with an infected pilon fracture nonunion developed Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) after prolonged intravenous vancomycin and implantation of a vancomycin/tobramycin-loaded antibiotic cement spacer (ACS). Fevers, rash, and eosinophilia persisted despite stopping systemic vancomycin and starting corticosteroids. ACS explantation led to symptom resolution; however, severe thrombocytopenia developed, requiring therapeutic plasma exchange. A daptomycin-loaded spacer was reimplanted before definitive hindfoot fusion.
Conclusion:
This case of DRESS in the setting of an ACS highlights management challenges, supports early recognition and spacer removal, proposes a treatment algorithm, and suggests daptomycin as an alternative for local antibiotic delivery.
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