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More than skin deep, a rare case of DRESS secondary to Vimovo complicated by severe, acute myocarditis.
  • Sarah O'Mahony,
  • Anne Marie Tobin,
  • Teresa Donnelly
Sarah O'Mahony

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Anne Marie Tobin
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Teresa Donnelly
Midland Regional Hospital Tullamore
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Abstract

A sixty-year-old male presented with three-day history of a widespread erythematous rash with associated chills, paraesthesia, and haematuria. On review of medications, he had recently been commenced on Vimovo (Naproxen/Esomeprazole) 500mg/20mg twice daily for a week for back pain. Bloods showed hypereosinophilia and a moderate acute kidney injury. Histology revealed parakeratosis, mild spongiosis with eosinophils. His admission was complicated by the acute onset of rapid atrial fibrillation with acute coronary syndrome. Coronary angiogram was non-obstructive. Cardiac MRI revealed acute myocarditis. This was felt to be a complication secondary to Drug reaction with eosinophilia and systemic symptoms (DRESS). In addition to his cardiac management, he was treated with oral corticosteroids and supportive care. Naproxen/Esomeprazole was stopped. On repeat cardiac MRI 3 months later his myocarditis had resolved, and his skin remains clear. DRESS is a rare drug induced hypersensitivity reaction that includes skin eruption, haematological abnormalities, lymphadenopathy, and internal organ involvement which has morality rate of up to 10%. The objective of this case report is to highlight the significant cardiac complications that can ensue. Naproxen/Esomeprazole was the culprit drug which is rare. There has been one previous case of DRESS secondary to NSAID with myocarditis. However, it presented as cardiogenic shock. This case was complicated by arrythmia and acute coronary syndrome. DRESS warrants prompt recognition with identification of causative drug and withdrawal. Multiorgan complications can be severe, and treatment should not be delayed. DRESS should always be considered with a new onset rash in the context of a new medication.