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Teicoplanin/vancomycin DRESS syndrome associated with reactivation of human herpes virus 6: case report A 52-year-old woman developed drug rash with eosinophilia and systemic symptoms [DRESS] syndrome during treatment with teicoplanin followed by vancomycin. The woman started receiving teicoplanin 800 mg/day for meticillin-resistant Staphylococcus aureus infection following tympanoplasty for cholesteatoma in her right ear. She developed a generalised skin eruption with a fever 2 weeks later. Teicoplanin was discontinued and the woman started receiving vancomycin 1 g/day. Her skin eruption initially improved slightly. However, a few days later, it worsened and her general condition deteriorated. Examination showed fever and lymphadenopathy and she had erythematous papules and macules covering her skin, and facial oedema. Her WBC count was 25.1 × 109/L with 1% atypical lymphocytes and 7.3% eosinophils. She had liver and renal dysfunction, with the following increased levels: serum creatinine 3.58 mg/dL, ALT 547 U/L, AST 358 U/L, ALP 2209 U/L and lactate dehydrogenase 393 U/L. An abdominal skin biopsy revealed epidermal lymphocytic infiltration with partial liquefaction degeneration of basal cells, and dermal perivascular lymphocytic infiltration. An antibody test revealed an increase in anti-human herpes 6 virus IgG titre from 1:40 to 1:320 over the last 3 weeks. Vancomycin was stopped 2 weeks after onset and she started receiving methylprednisolone. Her skin eruption, renal and liver function improved markedly. Prednisolone was continued and then tapered and her symptoms improved. Just after recovery and at 6 months later, lymphocyte stimulation tests for teicoplanin and vancomycin were positive; the stimulation index was 652% and 1648% for teicoplanin and vancomycin, respectively, just after recovery and 235% and 1351%, respectively, 6 months later. DRESS syndrome was diagnosed based on these results. Tamagawa-Mineoka R, et al. DRESS syndrome caused by teicoplanin and vancomycin, associated with reactivation of human herpesvirus-6. International 801092070 Journal of Dermatology 46: 654-655, No. 6, Jun 2007 - Japan

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