with previous reports of teicoplanin-induced DRESS. Additional work-up was performed to evaluate hematological abnormalities and organ involvement, which revealed leukocytosis with eosinophilia and liver involvement. It is noticeable that the patient work-up remained incomplete. Chest x-ray or computerized tomography scan and skin biopsy were not performed due to patient non-compliance. Therefore, pulmonary involvement was judged only on the basis of clinical symptoms. The Case Report A 37-year-old woman was admitted to hospital with redness and edema of inguinal area. The involved area was tender and warm on examination. With a presumptive diagnosis of cellulitis, vancomycin 1 g twice daily was PF-562271 prescribed. After 24 h, due to the acceptable clinical state of the patient, treatment was planned to be completed in the ambulatory setting. Vancomycin was replaced with teicoplanin, considering its ease of administration as an intramuscular injection. On the 14th day of treatment, the patient developed generalized maculopapular rash, accompanied by fever, wheezing, shortening of breath, and cervical and axillary lymphadenopathy. Lab tests revealed abnormal liver enzymes, leukocytosis with eosinophilia to more than 8%, a blood urea nitrogen value of 24 mg/dL, and a serum creatinine value of 0.8 mg/ dL. The treatment was interrupted with suspicion of drug reaction. After 48 h, the patient defervesced. Skin eruption and respiratory symptoms began to resolve within 2 weeks. The follow-up lab test performed 1 month later indicated resolution of liver dysfunction. Fig. 1 Generalized maculopapular rash on the neck and trunk Drug Reaction with Eosinophilia and Systemic Symptoms with Teicoplanin: A Case Report Page 3 of 4 1 Item Fever C38.5 C Enlarged lymph nodes Eosinophilia: C700 or C10%; C1500 or C20% Atypical lymphocytes Rash C50% of body surface area Rash suggestive Skin biopsy suggesting alternative diagnosis Organ involvement: 1; C2 Disease duration. Testing for human herpesvirus-6, human herpesvirus-7, and Epstein-Barr virus antibodies was not requested because of limited resources. In general, our presumptive diagnosis was mainly based on clinical signs and symptoms and accessible lab tests. On the basis of the scoring systems mentioned above, the reaction was rated as probable according to RegiSCAR and PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/19803812 possible according to Kardaun et al.’s scoring system. Since presence of atypical lymphocytes and reactivation of human herpesvirus were not investigated, DRESS was not confirmed by the Japanese group’s criteria for diagnosis of DRESS/DIHS. Regardless of the aforementioned limitations, the clinical picture was in favor of DRESS. Anticonvulsants with aromatic structure are the most common agents associated with DRESS. The aromatic structure of vancomycin and teicoplanin may explain the occurrence of DRESS with these agents. In this case, teicoplanin was used instead of vancomycin according to the Summary of Product Characteristics. Given the similar structure of vancomycin and teicoplanin, cross-reactivity is anticipated. Therefore, vancomycin may have prompted the reaction with teicoplanin. Resolution of symptoms after discontinuation of teicoplanin highlights it as the causative agent. Withdrawal of the offending medication and supportive care are the mainstay of management. The implementation of additional treatment including intravenous immunoglobulins, corticosteroids and antivirals is generally based on experience rather than proven benefi