Vancomycin leading to lupus flare in an elderly lady: a case report

Area of Science:

• Ophthalmology
• Rheumatology
• Dermatology

Background:

• Post-operative endophthalmitis is a serious ocular infection requiring prompt treatment.
• Vancomycin is a common antibiotic used for Gram-positive bacterial infections, including those causing endophthalmitis.

Observation:

• An elderly female developed endophthalmitis after vitreous clot removal surgery.
• She was treated with piperacillin/tazobactam and vancomycin, but required evisceration.
• Following discharge on home intravenous vancomycin, she presented with oral ulcers, fever, and a body rash.

Findings:

• Investigations revealed elevated double-stranded deoxyribonucleic acid and anti-histone antibodies.
• Skin biopsy was consistent with a lupus rash.
• These findings indicated drug-induced lupus erythematosus (DILE) secondary to vancomycin.

Implications:

• This case highlights a rare but significant adverse reaction to vancomycin.
• Early recognition and discontinuation of the offending agent, along with corticosteroid therapy, are crucial for managing vancomycin-induced lupus.
• Ophthalmologists and infectious disease specialists should be aware of this potential complication.