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Vancomycin-induced toxic epidermal necrolysis.
B A Hannah1, P L Kimmel, S Dosa
1Department of Medicine, George Washington University Medical Center, Washington, DC 20037.
Southern Medical Journal
|June 1, 1990
Summary
Vancomycin use in a renal transplant patient led to toxic epidermal necrolysis, a severe skin reaction. Prompt recognition and steroid treatment were crucial for managing this adverse drug event.
Area of Science:
- Nephrology
- Dermatology
- Pharmacology
Background:
- End-stage renal disease (ESRD) necessitates renal transplantation.
- Post-transplant infections are common and require antibiotic treatment.
- Intravenous antibiotics like vancomycin are frequently used in transplant recipients.
Observation:
- A patient with a history of renal transplantation developed fever and presumed sepsis.
- Treatment involved intravenous tobramycin and vancomycin.
- The patient subsequently presented with persistent fever, eosinophilia, and a progressive maculopapular rash evolving into linear bullae.
Findings:
- Skin biopsy findings were consistent with toxic epidermal necrolysis (TEN).
- Measurable serum vancomycin concentrations were sustained.
- The temporal relationship between vancomycin exposure and symptom onset, along with a positive response to steroid therapy, strongly implicated vancomycin.
Implications:
- Vancomycin can induce severe cutaneous adverse drug reactions, including TEN, in renal transplant recipients.
- Close monitoring for adverse effects is essential during vancomycin therapy in immunocompromised patients.
- Early recognition and management with corticosteroids may improve outcomes in vancomycin-induced TEN.