Persistent Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome Associated With Vancomycin-Impregnated Orthopedic Cement: A Case Report
Year: 2026
Type: article
Study design: Case Report
Abstract: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe delayed hypersensitivity reaction most commonly associated with anticonvulsants and antibiotics. We describe a 50-year-old woman with chronic polymicrobial prosthetic joint infection (PJI) whose course was complicated by refractory DRESS attributed to vancomycin. Despite discontinuation of systemic vancomycin, disease activity persisted for months and required high-dose corticosteroids, mycophenolate mofetil, intravenous immunoglobulin, benralizumab, and cyclosporine. Ongoing antigen exposure from vancomycin-containing orthopedic cement and an antibiotic-coated intramedullary nail was suspected. Her prolonged hospitalization was complicated by cytomegalovirus (CMV) reactivation, steroid-induced hyperglycemia, acute kidney injury, severe edema, chronic pain, and recurrent infection. Ultimate management required removal of antibiotic cement and hardware, prolonged antimicrobial therapy, and multidisciplinary coordination. This case suggests that implanted antibiotic-containing orthopedic materials may perpetuate DRESS despite cessation of systemic drug exposure.
Source: Cureus
Author: Trey J Dschaak
Institution: University of Colorado System
Language: English
Subfield: Pharmacology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214892300