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Korean J Pediatr 2013 May;56(5) :224-226.
Published online 2012 November 29.        doi:https://doi.org/10.3345/kjp.2013.56.5.224
Liver transplantation in a child with acute liver failure resulting from drug rash with eosinophilia and systemic symptoms syndrome
Seung Min Song1, Min Sung Cho1, Seak Hee Oh1, Kyung Mo Kim1, Young Seo Park1, Dae Yeon Kim2, Sung Gyu Lee3
1Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
2Department of Pediatric Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
3Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding Author: Kyung Mo Kim ,Tel: +82-2-3010-3380, Fax: +82-2-473-3725, Email: kmkim@amc.seoul.kr
Copyright © 2013 by The Korean Pediatric Society
ABSTRACT
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by a severe idiosyncratic reaction including rash and fever, often with associated hepatitis, arthralgias, lymph-node enlargement, or hematologic abnormalities. The mortality rate is approximately 10%, primarily owing to liver failure with massive or multiple disseminated focal necrosis. Here, we report a case of a 14-year-old girl treated with vancomycin because of a wound infection by methicillin-resistant Staphylococcus aureus , who presented with non-specific symptoms, which progressed to acute liver failure, displaying the hallmarks of DRESS syndrome. With the presence of aggravated hepatic encephalopathy and azotemia, the patient was refractory to medical treatments, she received a living-donor liver transplantation, and a cure was achieved without any sign of recurrence. Vancomycin can be a cause of DRESS syndrome. A high index of suspicion and rapid diagnosis are necessary not to miss this potentially lethal disease.
Keywords: DRESS syndrome | Vancomycin | Acute liver failure | Liver transplantation
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