Tara Shankar MD, Merritt L. Fajt MD
Merritt Fajt MD, Atypical DRESS Syndrome in a Post-Partum Patient(2015)Journal Of Advances In Allergy & Immunologic Diseases 1(1)
We present a case of a 35-year-old female 14 days postpartum evaluated in the hospital for a diffuse pruritic papular rash. Her peripartum course was complicated by preeclampsia and liver rupture necessitating emergent caesarean-section with exploratory laparotomy and partial hepatectomy. Subsequently, she developed coagulase-negative staphylococcal bacteremia and was discharged with a 2-week vancomycin course. Four days after vancomycin completion she had partially blanchable pink papules over the face, arms, legs, and trunk and fever. She was started on prednisone and re-started on vancomycin. Laboratory evaluation revealed a normal white blood cell count (5.7x103/?L) with atypical lymphocytes. Drug reaction with eosinophilia and systemic symptoms (DRESS) was suspected secondary to vancomycin. Vancomycin was discontinued and the patient was treated with oral prednisone with complete resolution of symptoms within one week. DRESS syndrome is potentially life-threatening with significant morbidity. Prompt diagnosis is vital along with identification and withdrawal of suspect medications. Clinicians should be aware of the varying clinical presentations of DRESS syndrome, including the likelihood of masking peripheral eosinophilia with steroid administration.