Vancomycin Infiltrate-Induced Dermatitis Mimicking Bullous Cellulitis

Area of Science:

• Dermatology
• Pharmacology
• Infectious Diseases

Background:

• Extravasation of intravenous medications can lead to severe complications, including tissue necrosis and infection.
• While potent vesicants are often handled with caution, antimicrobial agents like vancomycin, due to their low pH, can also cause vascular damage.
• Risk factors include mechanical and pharmacological elements affecting drug leakage.

Observation:

• A patient presented with dermatitis and cellulitis that mimicked infectious causes, such as those from Staphylococcus aureus or gram-negative rods.
• The symptoms were suspected to be a result of vancomycin extravasation from a peripheral intravenous catheter.
• The presentation resembled hypersensitivity reactions like linear immunoglobulin A bullous dermatosis.

Findings:

• Vancomycin's acidic pH (2.5-4.5) can damage the vascular wall, leading to extravasation injuries.
• The patient's rash and cellulitis were likely caused by vancomycin extravasation, not a bacterial infection.
• The clinical presentation mimicked bullous cellulitis, particularly in a neutropenic patient.

Implications:

• Highlights the importance of considering non-infectious etiologies, such as drug extravasation, when diagnosing skin rashes.
• Emphasizes the need for thorough patient history to differentiate between infectious and non-infectious causes of dermatitis.
• Underscores the potential for commonly used antimicrobials like vancomycin to cause significant local tissue injury.