Diffuse Desquamating Rash Following Exposure to Vancomycin-Impregnated Bone Cement.

Area of Science:

• Dermatology
• Infectious Diseases
• Pharmacology

Background:

• Antibiotic-laden cement (ABLC) is used for prosthetic joint infections.
• Systemic absorption of antibiotics from ABLC can occur, though toxicity is rare.
• Patients with a history of severe drug reactions require careful consideration for ABLC use.

Purpose of the Study:

• To report a case of systemic desquamating dermatitis.
• To investigate a potential hypersensitivity reaction to vancomycin from ABLC.
• To emphasize the importance of patient allergy history in ABLC procedures.

Main Methods:

• A 59-year-old male with a history of Stevens-Johnson syndrome (SJS) to vancomycin received vancomycin ABLC for a prosthetic knee infection.
• The patient developed a painful, blistering, desquamating rash approximately one week post-implantation.
• The Naranjo nomogram was used to assess the probability of an adverse drug reaction.

Main Results:

• The patient experienced a diffuse, painful, desquamating rash following ABLC implantation.
• The Naranjo nomogram indicated a probable adverse reaction to vancomycin (score of 8).
• The reaction was consistent with a less-severe form of systemic hypersensitivity to vancomycin, despite lacking classic SJS features.

Conclusions:

• Systemic absorption of vancomycin from ABLC can lead to hypersensitivity reactions, even in patients with a prior history of SJS.
• Antibiotics to which a patient has a history of severe reactions should be avoided in ABLC formulations.
• Thorough review of antibiotic allergy history is crucial before implanting ABLC to prevent adverse events.