SHM Converge Scientific Abstract ePoster Gallery-A Fatal Case of Augmentin-Induced Myocarditis in the Setting of Drug Rash With Eosinophilia Systemic Symptoms (Dress)

Pdf Summary

This case describes a fatal instance of Augmentin-associated drug reaction with eosinophilia and systemic symptoms (DRESS) complicated by myocarditis. A 44-year-old woman with hypertension and depression developed three days of worsening diffuse rash, fever, and leukocytosis about four weeks after completing a two-week course of Augmentin for sinusitis. Before arrival, she had diffuse erythroderma with pustules, eosinophilia, and biopsy findings consistent with a drug eruption. She was treated with prednisone, which was increased after dermatology evaluation.<br /><br />In the emergency department, she was febrile, tachypneic, and tachycardic, with bibasilar lung opacities on imaging. Her RegiSCAR score was 4, indicating probable DRESS syndrome. Cardiac findings were concerning for severe myocarditis: troponin was elevated at 0.52 ng/mL initially, and EKG showed lateral ST-segment elevation in leads I and aVL. CTA of the chest ruled out pulmonary embolism but showed bilateral multifocal ground-glass opacities.<br /><br />Before coronary angiography could be performed, the patient worsened rapidly, requiring ICU transfer for increased work of breathing, elevated lactate, and a sharply rising troponin of 15.24 ng/mL. She then suffered a PEA arrest, briefly achieved ROSC, and had a second arrest with unsuccessful resuscitation.<br /><br />The report emphasizes that DRESS is a severe delayed hypersensitivity reaction typically occurring 2 to 8 weeks after drug exposure and can affect the liver, kidneys, lungs, and heart. Myocarditis is a rare but highly lethal complication, with acute necrotizing eosinophilic myocarditis (ANEM) associated with ST elevation, eosinophilia, cardiac biomarker elevation, rash, and sudden cardiac arrest. This case is notable as the first reported Augmentin-triggered DRESS syndrome leading to fatal myocarditis.

Asset Subtitle

Casey R. Smith

Meta Tag

Author List Abu Baker Sheikh, Casey R. Smith, Kimberly Benavidez, Megan Pignato, Nicholas F. Parchim

Category Clinical Vignettes

Concept Drug Reaction with Eosinophilia and Systemic Symptoms

Concept Myocarditis

Concept Acute necrotizing eosinophilic myocarditis

Concept Offending Agent Withdrawal

Concept RegiSCAR criteria

Distinguished Non-Finalist

Presenter Organization University of New Mexico Hospital Department of Internal Medicine

Presenting Author Casey R. Smith

Track Adult

Keywords

Augmentin

DRESS syndrome

myocarditis

eosinophilia

drug reaction

drug hypersensitivity

acute necrotizing eosinophilic myocarditis

rash

cardiac arrest

RegiSCAR score

Drug Reaction with Eosinophilia and Systemic Symptoms

Myocarditis

Acute necrotizing eosinophilic myocarditis

Offending Agent Withdrawal

RegiSCAR criteria