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Vancomycin-associated exfoliative dermatitis during continuous ambulatory peritoneal dialysis
M B Gutfeld1, P V Reddy, G D Morse
1State University of New York, Buffalo.
Abstract:
Vancomycin is commonly prescribed to patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for catheter-related infections and acute episodes of peritonitis. Although adverse dermatological reactions have been reported secondary to the rapid intravenous infusion of vancomycin, the intraperitoneal route of administration has been used routinely during CAPD without these effects. This case report describes a CAPD patient with systemic lupus erythematosus who developed erythema multiforme that progressed to exfoliative dermatitis during intermittent intraperitoneal vancomycin therapy for a catheter-related exit-site/tunnel infection.
Insights
A continuous ambulatory peritoneal dialysis patient developed severe skin reactions, including erythema multiforme and exfoliative dermatitis, from intraperitoneal vancomycin. This contrasts with typical safety profiles for this common infection treatment in CAPD patients.
Area of Science:
- Nephrology
- Dermatology
- Infectious Diseases
Background:
- Vancomycin is a standard treatment for infections in patients on continuous ambulatory peritoneal dialysis (CAPD).
- Intraperitoneal vancomycin is generally considered safe in CAPD, with few reported dermatological side effects.
- Adverse skin reactions are more commonly associated with rapid intravenous vancomycin administration.
Observation:
- This case report details a CAPD patient with a history of systemic lupus erythematosus.
- The patient received intermittent intraperitoneal vancomycin for a catheter-related exit-site/tunnel infection.
- The patient developed erythema multiforme, which subsequently progressed to exfoliative dermatitis.
Findings:
- Intraperitoneal vancomycin therapy can precipitate severe dermatological reactions, such as erythema multiforme and exfoliative dermatitis.
- These reactions may occur even when vancomycin is administered via the intraperitoneal route in CAPD patients.
- The development of these reactions might be influenced by underlying conditions like systemic lupus erythematosus.
Implications:
- Clinicians should be vigilant for potential severe skin reactions in CAPD patients receiving intraperitoneal vancomycin, especially those with comorbidities.
- This case highlights the need for careful monitoring and consideration of alternative treatments if dermatological adverse events arise.
- Further investigation may be warranted to understand the specific mechanisms and risk factors for vancomycin-induced dermatological toxicity in the CAPD population.