Case of drug reaction with eosinophilia and systemic symptoms secondary to vancomycin.

A 38-year-old man with a medical history of hepatitis C presented with a 2-day pruritic rash. It started on his back and generalised within 2 days. The patient had been on vancomycin for the last 3 weeks due to a recent diagnosis of osteomyelitis. He was not taking other medications. On physical examination, a diffuse blanching maculopapular exanthema was noted (figure 1A and B) associated to facial angioedema and palpable axillary and inguinal lymph nodes. Laboratory evaluation was relevant for leucocytosis with neutrophilia and eosinophilia, mild elevation of liver function tests and peripheral blood smear revealing atypical lymphocytes (figure 2). Skin biopsy demonstrated superficial perivascular …