Vancomycin-Induced Liver Injury, DRESS, and HLA-A∗32:01.

Area of Science:

• Hepatology
• Pharmacogenomics
• Immunology

Background:

• Intravenous vancomycin can cause liver injury and DRESS syndrome.
• Understanding vancomycin-induced liver injury (VILI) clinical features and HLA associations is crucial.

Purpose of the Study:

• To define the clinical characteristics of VILI.
• To identify HLA associations with VILI.

Main Methods:

• Assessed cases of VILI within the US Drug-induced Liver Injury Network (2004-2020).
• Performed HLA allele sequencing on patient blood samples.

Main Results:

• Nine cases (0.5%) of VILI were identified, predominantly presenting as DRESS syndrome (8/9 patients).
• The HLA-A∗32:01 allele was found in 78% of VILI cases with DRESS syndrome, significantly higher than controls.
• VILI cases showed a higher frequency of HLA-A∗32:01 (0.44) compared to the general US population (<0.04).

Conclusions:

• VILI is frequently associated with DRESS syndrome and the HLA-A∗32:01 allele.
• Consider HLA-A∗32:01 testing for risk stratification in patients receiving long-term vancomycin.