When everything goes wrong

The Bentall procedure was described for the first time 50 years ago and has undergone several improvements through the years. This technique is considered to be a longstanding and safe procedure. However, as any surgery, it can have several complications such as anastomotic pseudoaneurism, myocardial infarction and endocarditis. In developed countries with differentiated access to health care and prophylaxis, endocarditis is an uncommon pathology, associated to frequent complications and high mortality rates. Antibiotic therapy aims to eradicate the responsible microorganism. However, some of the drugs used cause several side effects, like the DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome. The DRESS syndrome was firstly described by Bocquet et. al. in 1996, in patients with constitutional symptoms, lymphadenopathy and peripheral eosinophilia. It is considered a severe idiosyncratic and hypersensitivity reaction to drugs, with extensive clinical features. Its incidence is unknown, but it occurs more frequently in adults. Several drugs were associated to DRESS, yet vancomycin is one of the most frequent ones. DRESS has a broad spectrum of clinical conditions, ranging from mild symptoms to multiple-organ failure. However, drug exposing time, individual susceptibility and prompt diagnosis can influence the patient's response. Mortality rates range from 3 to 10% and prompt diagnosis and drug withdrawal is important to achieve a favorable outcome. The authors present a unique case that reflects a set of sporadic events that occurred in one patient. (author)