[Teicoplanin-induced hypersensitivity syndrome in a diabetic foot patient with malignant ulcer]

A 58-year-old male patient with diabetic foot ulcer was admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine on December 11, 2018. The patient was treated with local debridement, vacuum sealing drainage treatment, and dressing change and discharged after basic wound healing. On January 15, 2019, the patient was hospitalized again due to local infection and rupture of wound surface. He underwent a surgical debridement on the third day after second admission and was given intravenous infusion of 0.4 g teicoplanin twice daily. Histopathological examination after surgery showed keratinizing squamous-cell carcinoma. An extended squamous-cell carcinoma resection plus autologous split-thickness skin grafting and vacuum sealing drainage treatment was carried out on the 10th day after second admission. The patient's whole body turned red after surgery with rash, recurrent fever over 39 ℃, leucopenia, and thrombocytopenia. A multi-disciplinary consultation of physicians attributed these symptoms to teicoplanin-induced hypersensitivity syndrome. After withdrawal of teicoplanin and administration of hormone, the patient's temperature returned to normal, and the leucocyte count and platelet count recovered gradually. The patient was cured and discharged on the 49th day after second admission. The case presented reminds us of need to strictly follow the indications of teicoplanin prior to medication, be resolute to the administration and withdrawal, and be alert to adverse drug reactions when above-mentioned abnormalities occur, meanwhile, infection and rheumatic diseases are excluded.