Vancomycin flushing syndrome in orthopaedic practice: A case report

Area of Science:

• Infectious Diseases
• Pharmacology
• Allergy & Immunology

Background:

• Vancomycin flushing syndrome (VFS), or red man syndrome, is an allergic reaction to vancomycin, typically presenting as a rash after rapid intravenous infusion.
• While VFS is commonly associated with intravenous administration, it rarely occurs after local vancomycin use.

Observation:

• A case of VFS is presented in a 44-year-old male with chronic osteomyelitis who received vancomycin cement beads for treatment.
• The patient developed a pruritic, erythematous rash predominantly on the face, neck, chest, and extremities three hours postoperatively.

Findings:

• The diagnosis of VFS was confirmed, and the patient was successfully treated with oral cetirizine and intravenous methylprednisolone sodium succinate.
• The vancomycin cement beads were not removed, and the patient's rash gradually resolved within 96 hours without further complications.

Implications:

• This case highlights that VFS can occur due to slow local absorption of vancomycin, as seen with vancomycin cement beads.
• Orthopaedic surgeons frequently use vancomycin with polymethyl methacrylate for chronic osteomyelitis and revision arthroplasty and must be aware of this potential complication.