多彩な免疫再構築症候群の症状を呈した重症COVID–19の1例(Various IRIS–like symptoms following severe COVID–19 infection: a case report)

ABSTRACT Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction associated with organ failure. DRESS’s pathogenesis is related to immune reconstitution inflammatory syndrome (IRIS). We report a coronavirus disease (COVID–19) case with severe pneumonia, wherein DRESS developed as a symptom of IRIS. A 56–year–old man underwent venovenous extracorporeal membrane oxygenation (VV–ECMO) to treat severe COVID–19. He developed ventilator–associated pneumonia and was treated with Meropenem from the third to the sixth day. During treatment, lung abscess caused by multidrug–resistant Pseudomonas aeruginosa and Enterobacter cloacae bacteremia developed, but he was weaned from VV–ECMO within a month. On the 37th day, papules and an erythematous rash appeared throughout his body, and fever, tachycardia, hypotension, and acute kidney injury (AKI) were reported. The condition was diagnosed as DRESS according to the RegiSCAR criteria. Meropenem was suspected as the cause based on the drug–induced lymphocyte stimulation test. The patient’s vitals stabilized, skin rash, and AKI improved after steroid administration. However, generalized herpes zoster and Ramsay–Hunt syndrome developed upon decreasing the steroids; hence, the steroid dose was increased. DRESS and zoster reactivation can occur during severe COVID–19 recovery. Therefore, it is advisable to use steroids appropriately and reduce the dose carefully.