Systemic Toxicity of Intraperitoneal Vancomycin

Area of Science:

• Nephrology
• Pharmacology
• Toxicology

Background:

• Intraperitoneal vancomycin is a standard empiric treatment for peritoneal dialysis peritonitis.
• High systemic concentrations are often achieved with intermittent dosing, yet systemic toxicity is rarely reported.
• Peritoneal dialysis patients are susceptible to infections requiring effective antibiotic management.

Purpose of the Study:

• To report the first case of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome associated with intraperitoneal vancomycin.
• To review existing literature on systemic toxicity from intraperitoneal vancomycin.
• To raise awareness of potential severe adverse drug reactions in peritoneal dialysis patients.

Main Methods:

• A case report of a patient developing DRESS syndrome after three weeks of intraperitoneal vancomycin treatment.
• Comprehensive literature review of adverse events related to intraperitoneal vancomycin.
• Clinical assessment and diagnostic criteria for DRESS syndrome.

Main Results:

• The patient developed DRESS syndrome, a severe systemic drug reaction, after receiving intraperitoneal vancomycin.
• Literature search revealed no prior documented cases of DRESS syndrome from intraperitoneal vancomycin.
• This represents the first reported instance of this specific adverse drug reaction.

Conclusions:

• Intraperitoneal vancomycin, despite its common use, can lead to severe systemic toxicity like DRESS syndrome.
• Clinicians should be vigilant for signs of DRESS syndrome in patients undergoing peritoneal dialysis and treated with vancomycin.
• Further investigation into the mechanisms and incidence of vancomycin-induced DRESS syndrome in this population is warranted.