Case Report

Vancomycin-Induced DRESS Syndrome: An Important Concern in Orthopedic Surgery

Table 1

RegiSCAR scoring system for classifying cases of DRESS [7].


Fever > 38.4NoYes
Enlarged lymph nodesNoYes
EosinophiliaNo0.7–1.499 × 10−9/L>1.5 × 10−9/L
Atypical lymphocytesNoYes
Skin rash > 50% body surface areaNoYes
Skin rash suggesting DRESSNoYes
Biopsy suggesting DRESSNoYes
Organ involvementNo1 organ2 or more organs
Resolution > 14 daysNoYes
Evaluation of other potential causes (>2 negative of ANA, blood culture, hepatitis A/B/C, and chlamydia/mycoplasma)Yes

Score: <2 no case, 2-3 possible case, 4-5 probable case, >5 definite case. The diagnostic criteria met by this case are highlighted in italics, totaling a score of 5. If the enlarged lymph nodes and cardiac involvement are taken to be as a result of DRESS, the score rises to 7.