Ceftobiprole associated agranulocytosis after drug rash with eosinophilia and systemic symptoms induced by vancomycin and rifampicin

Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug hypersensitivity reaction [1]. Sulfonamides, antiepileptics, allopurinol, minocyclin, diltiazem, vancomycin and β-lactam antibiotics are the most common elicitors. Symptoms include fever, skin rash, facial oedema, organ involvement such as hepatitis or interstitial nephritis, pneumonitis and myocarditis. Lymphadenopathy and splenomegaly may occur. DRESS syndrome is characterized by the presence of eosinophilia and atypical lymyphocytes in blood. The syndrome occurs within 1–12 weeks after initiating drug treatment [2]. Mortality is around 10%, most often due to liver failure. Drug-specific circulating T-cells seem to play a central role in its pathogenesis [3].