Drug eruption secondary to vancomycin-laden spacer in the shoulder: a case report

Vancomycin-Induced DRESS Syndrome: A Systematic Review of Case Reports

Background: Vancomycin-induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe hypersensitivity reaction. It presents with rash, eosinophilia, fever, lymphadenopathy, and multi-organ involvement, most often leading to misdiagnosis and delayed treatment. This systematic review aims to identify risk factors, clinical presentations, and optimal management strategies for vancomycin-induced DRESS. Methods: Systematic search with PRISMA 2020 was conducted in PubMed, Scopus, Web of Science, and Google Scholar. Case reports from 2015 to 2025 were screened and demographic information, clinical presentation, risk factors, diagnostic assessment, and outcomes were extracted. Quality of included reports was evaluated with Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Report: The most common symptoms were rash, fever, eosinophilia, and hepatic/renal dysfunction, which typically appeared 2 to 9 weeks following exposure. Genetic predisposition (HLA associations), renal dysfunction, concomitant medications, and viral reactivation were significant risk factors. Rise of AST was shown after a time, and so diagnosis was difficult. Discontinuing vancomycin, administering corticosteroids, and supportive care were the most preferable interventions, with severe conditions requiring IVIG, plasmapheresis and immunosuppressants. Despite interventions, mortality remains high in elderly and immunocompromised patients. Conclusion: Vancomycin is one of the most frequent causes of antibiotic-induced DRESS syndrome, rarely accompanied by severe organ failure and mortality. Early detection, following consistent diagnosing criteria, and tailored treatment regimens are needed to improve patient outcomes and reduce the risk of mortality and improve wellbeing. More research is needed to explore genetic patterns and develop optimal treatment regimens.

Drug Reaction With Eosinophilia and Systemic Symptoms to Vancomycin-Laden Cement Space: A Case Report

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction mediated by a complex immune response. Vancomycin is a known cause of DRESS, and cases are often attributed to intravenous exposure. Vancomycin-laden bone cements deliver high concentrations of the drug locally with low to undetectable systemic levels. Despite trace systemic concentrations, cement spacers have been reported to cause systemic reactions ranging from organ failure to diffuse cutaneous eruptions. A patient receiving intravenous (IV) and local vancomycin, via bone cement, experienced symptom resolution only after the vancomycin-eluting bone cement was removed, which was done after the IV vancomycin had been stopped. This suggests that the vancomycin eluted from the local bone cement may be sufficient to maintain the immune response mediating DRESS syndrome. In patients who experience persistent symptoms despite discontinuing systemic drug exposure, clinicians should consider eliminating all sources of the causative drug.

Antibiotic Spacers for Shoulder Periprosthetic Joint Infection: A Review

Periprosthetic joint infection is a rare but potentially devastating complication of shoulder arthroplasty. The most conservative treatment approach is a two-stage revision involving interval placement of an antibiotic cement spacer. The purpose of this study was to contextualize the use of antibiotic spacers in the current treatment paradigm of shoulder periprosthetic joint infection and to review the history of shoulder spacers, the different types (eg, stemmed versus stemless and prefabricated versus handmade), the antibiotic composition and dosage, and their efficacy and complications.