Case
Published · Updated · 2 min read
Persistent DRESS associated with vancomycin-containing orthopedic cement
What it means for practice
When DRESS persists after systemic vancomycin withdrawal, consider implanted antibiotic-containing materials as a possible source of ongoing antigen exposure and discuss management within a multidisciplinary team.
Summary
A case describes a 50-year-old woman with chronic polymicrobial prosthetic joint infection whose course was complicated by refractory drug reaction with eosinophilia and systemic symptoms (DRESS). The author attributes the reaction to vancomycin. DRESS is characterized as a severe delayed hypersensitivity reaction.
Course and treatment
Despite discontinuation of systemic vancomycin, disease activity persisted for months. Treatment required high-dose corticosteroids, mycophenolate mofetil, intravenous immunoglobulin, benralizumab, and cyclosporine. Vancomycin-containing orthopedic cement and an antibiotic-coated intramedullary nail were suspected as sources of ongoing antigen exposure.
Prolonged hospitalization was complicated by cytomegalovirus reactivation, steroid-induced hyperglycemia, acute kidney injury, severe edema, chronic pain, and recurrent infection. Subsequent management required removal of antibiotic cement and hardware, prolonged antimicrobial therapy, and multidisciplinary coordination.
Practice implication
This case suggests that implanted antibiotic-containing orthopedic materials may perpetuate DRESS after systemic drug exposure has ceased. The abstract does not report the final outcome after material removal; their contribution is described as suspected rather than established. Source
Case analysis
- Likely mechanism
- DRESS is described as a severe delayed hypersensitivity reaction. The author proposes that vancomycin-containing orthopedic cement and an antibiotic-coated intramedullary nail sustained antigen exposure after systemic vancomycin was discontinued.
- Causality assessment
- Editorial WHO-UMC assessment: possible. The author attributes DRESS to vancomycin, but the abstract provides insufficient information on the temporal relationship, exclusion of alternative causes, and course after removal of implanted materials. No formal author-reported causality assessment is provided.
- Take-home lesson
- When DRESS persists after systemic drug withdrawal, consider possible ongoing exposure through implanted antibiotic-containing materials. Discussion of their contribution and subsequent management requires multidisciplinary coordination.
Source
-
Dschaak TJ. Persistent Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome Associated With Vancomycin-Impregnated Orthopedic Cement: A Case Report. Cureus. 2026;18(9):e117221. doi:10.7759/cureus.117221
PubMed 42965083 DOI 10.7759/cureus.117221 Original: pubmed.ncbi.nlm.nih.gov
Reviewed by: DrugCard editorial team ·
This article does not replace clinical judgement. Disclaimer