Korean J Pediatr.  2013 May;56(5):224-226. 10.3345/kjp.2013.56.5.224.

Liver transplantation in a child with acute liver failure resulting from drug rash with eosinophilia and systemic symptoms syndrome

• Song SM
• Cho MS
• Oh SH
• Kim KM
• Park YS
• Kim DY
• Lee SG

• KMID: 2284840
• DOI: http://doi.org/10.3345/kjp.2013.56.5.224

Abstract

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by a severe idiosyncratic reaction including rash and fever, often with associated hepatitis, arthralgias, lymph node enlargement, or hematologic abnormalities. The mortality rate is approximately 10%, primarily owing to liver failure with massive or multiple disseminated focal necrosis. Here, we report a case of a 14-year-old girl treated with vancomycin because of a wound infection by methicillin-resistant Staphylococcus aureus, who presented with non-specific symptoms, which progressed to acute liver failure, displaying the hallmarks of DRESS syndrome. With the presence of aggravated hepatic encephalopathy and azotemia, the patient was refractory to medical treatments, she received a living-donor liver transplantation, and a cure was achieved without any sign of recurrence. Vancomycin can be a cause of DRESS syndrome. A high index of suspicion and rapid diagnosis are necessary not to miss this potentially lethal disease.

Keyword

DRESS syndrome; Vancomycin; Acute liver failure; Liver transplantation

MeSH Terms

Arthralgia
Azotemia
Child
Eosinophilia
Exanthema
Fever
Hepatic Encephalopathy
Hepatitis
Humans
Liver
Liver Failure
Liver Failure, Acute
Liver Transplantation
Lymph Nodes
Methicillin-Resistant Staphylococcus aureus
Necrosis
Recurrence
Vancomycin
Wound Infection
Vancomycin