Vancomycin-associated Drug-Induced Hypersensitivity Syndrome (DIHS)

Publication date: Available online 6 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Lauren M. Madigan, Lindy P. Fox

Abstract

Background

While hypersensitivity reactions are well-characterized for certain medications, vancomycin-associated drug-induced hypersensitivity syndrome (DIHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), has yet to be defined.

Objective

To better define the clinical phenotype of vancomycin-associated DIHS.

Methods

A retrospective case series was conducted over an 8-year period at a single, academic institution. Twenty-nine patients with definitive DIHS/DRESS were identified, of which four cases were attributed to vancomycin. A literature review was performed which identified 28 additional cases of vancomycin-induced DIHS. Vancomycin-associated acute interstitial nephritis (AIN) was also reviewed to detect further, previously uncharacterized cases of systemic hypersensitivity. This yielded 11 additional cases.

Results

In this literature review and retrospective series, the incidence of renal dysfunction among vancomycin-induced cases (75% and 68% of cases in the series and literature respectively) was notably higher than the overall reported incidence in DIHS (10-40%). The degree of renal impairment was also significantly increased in the retrospective series (median 4.98-fold change in baseline creatinine vs. 2.25-fold increase in non-vancomycin associated cases; p = 0.011).

Limitations

The principal limitation of this study is the small sample size. Other notable limitations include the retrospective nature of the study and absence of confirmatory renal biopsies.

Conclusion

While the current understanding of DIHS/DRESS is imperfect, our findings suggest that vancomycin-induced cases present with a unique phenotype characterized by a higher burden of renal involvement.

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