Minocycline
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Multiple organ failure secondary to DRESS syndrome: case report A 16-year-old girl developed multiple organ failure secondary to DRESS syndrome following treatment with minocycline for acne. She subsequently died. The girl received minocycline [dosage and route not stated] for 3 weeks prior to developing fever, malaise, fatigue, urticaria, posterior cervical lymphadenopathy and a maculopapular rash alongside oedema of her face, limbs, and trunk. Laboratory tests showed an elevated WBC count with 6% eosinophils and mildly elevated liver enzymes. Minocycline was discontinued and a course of prednisone was initiated. After 2 weeks, repeat laboratory tests showed persistent leukocytosis with eosinophilia. An attempt to wean the girl’s prednisone, 8 weeks after originally initiating minocycline therapy, resulted in cardiogenic shock requiring intubation and cardiopulmonary resuscitation. She received treatment with broad spectrum antibiotics, immune globulin and high-dose methylprednisolone. Minocycline-induced eosinophilic myocarditis was suspected to be causative of her acute cardiomyopathy and she was diagnosed with DRESS syndrome. Subsequently, although her cardiomyopathy improved, she developed multiple system organ failure involving the liver and kidneys alongside ischaemic colitis. She also experienced multiple episodes of hypotension secondary to bacteraemia and fungaemia. On hospital day 93, she was weaned off the ventilator but subsequently developed a pulmonary embolus and was placed back on mechanical ventilatory support. Her condition continued to deteriorate and on day 102 she died [cause of death not stated]. Author comment: "If not diagnosed and treated in a timely manner, DRESS syndrome has life threatening consequences. Though her cardiomyopathy resolved, through the support of external cardiac assist devices, our patient was unable to overcome the damage caused to her other vital organs by such prolonged ischemia." Taylor JL, et al. Minocycline-Induced Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome: Myocarditis and Multiple Organ Failure. ICU Director 3: 139-143, No. 3, May 2012. Available from: URL: http:// 803078417 dx.doi.org/10.1177/1944451612442687 - USA
0114-9954/10/1423-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 13 Oct 2012 No. 1423
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