Various drugs
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DRESS syndrome leading to stroke in an elderly patient: case report A 79-year-old woman developed DRESS syndrome leading to stroke following administration of aspirin, atorvastatin, ciprofloxacin, ketorolac [Toradol], spironolactone and vancomycin [dosages and routes not stated; some indications and durations of treatments to reaction onsets not stated]. The woman, who had a history of multiple drug allergies, was admitted for an elective total shoulder arthroplasty. She was receiving home medication including aspirin, atorvastatin and spironolactone. Several weeks prior to surgery, she had started ciprofloxacin for urinary tract infection prophylaxis. She received vancomycin following arthroplasty, and also received ketorolac during hospitalisation. Twelve hours after receiving her third dose of vancomycin, she developed an erythematous maculopapular rash. Red man syndrome was suspected. Vancomycin was discontinued, and the woman received diphenhydramine. She subsequently developed somnolence, delirium, oliguria, a left sided facial droop and slurred speech. Brain imaging revealed ischaemia in the posterior right frontal lobe. Her rash progressed with an increase in size of erythematous patches and plaques. The following day, she developed a fever and leucocytosis with 7.0% eosinophils and atypical lymphocytes. Liver function tests were elevated. DRESS syndrome was clinically suspected, and the diagnosis was corroborated by a punch biopsy. She received prednisone. Subsequently, her fever, delirium and neurological symptoms resolved, while her laboratory tests improved. Author comment: The woman was receiving "aspirin, atorvastatin, and spironolactone, all of which have been linked to documented cases of DRESS. . . [Quinolones] are known to cause drug hypersensitivity reactions. The patient received 17 other medications during her hospital stay including known culprit drugs Toradol and vancomycin. The timing of the acute stroke raises the possibility that DRESSassociated systemic inflammation may lead to an increased risk of thromboembolism". Day MO, et al. The dangers of dress syndrome with polypharmacy. Journal of the American Geriatrics Society 61 (Suppl. 1): S80 abstr. B21, Apr 2013. Available 803086425 from: URL: http://dx.doi.org/10.1111/jgs.12263 - USA
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Reactions 4 May 2013 No. 1450
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