Stevens-Johnson syndrome induced by the cross-reactivity between teicoplanin and vancomycin

Area of Science:

• Pharmacology
• Dermatology
• Infectious Diseases

Background:

• Vancomycin and teicoplanin are critical glycopeptide antibiotics for treating severe Gram-positive infections, including methicillin-resistant Staphylococcus aureus.
• Stevens-Johnson syndrome (SJS) is a severe mucocutaneous adverse drug reaction.

Observation:

• A 74-year-old patient with chronic obstructive pulmonary disease (COPD) developed a widespread rash after 12 days of teicoplanin therapy for infective endocarditis.
• The rash rapidly progressed to SJS within 7 days of switching to vancomycin, and recurred upon re-introduction of teicoplanin.
• The patient recovered after discontinuation of both vancomycin and teicoplanin.

Findings:

• This is the first reported case of SJS induced by sequential therapy with teicoplanin and vancomycin.
• Pharmacogenetic analysis revealed the patient was heterozygous for variants in MUC21 and BAG6, which may be associated with SJS/TEN susceptibility.
• Cross-reactivity between vancomycin and teicoplanin, leading to SJS, is considered rare.

Implications:

• Clinicians should exercise caution when prescribing vancomycin to patients with a history of skin reactions to teicoplanin.
• Consider genetic susceptibility testing for patients with a history of adverse skin reactions to glycopeptide antibiotics.
• This case underscores the potential for rare but severe cross-reactivity between vancomycin and teicoplanin.