Vancomycin-Induced Drug Reaction with Eosinophiliaand Systemic Symptoms (DRESS) Syndrome Masqueradingas Elusive Sepsis

We present a unique case of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndromemasquerading as elusive endocarditis. A 37-year-old female actively using intravenous drugs presented with worsening right upperextremity pain, fever, and chills. Workup revealed methicillin-resistant staphylococcus aureus (MRSA) bacteremia and multipleright-sided septic pulmonary emboli. Echocardiogram was negative for vegetation. Vancomycin was initiated for bacteremiamanagement suspected secondary to right upper extremity abscesses. However, despite resolution of abscesses, fevers persisted,raising suspicion for endocarditis not detected by echocardiogram. On hospital day 25, the patient began showing signs of DRESSsyndrome, ultimately manifesting as transaminitis, eosinophilia, and a diffuse, maculopapular rash. Vancomycin was switched toLinezolid and she improved on high dose steroids. The persistent fevers throughout this hospital course were thought to be anelusive endocarditis before DRESS syndrome fully manifested. Although Vancomycin-induced DRESS is uncommon, this casehighlights the importance of identifying early signs of significant adverse effects