Delayed appearance of vancomycin-induced neutropenia in a patient with chronic renal failure

A patient receiving hemodialysis for chronic renal failure had neutropenia six weeks after administration of his last dose of intravenous vancomycin and in the absence of other drug therapy. This case provides confirmation that neutropenia can be seen with vancomycin therapy; suggests an immunologic basis for the reaction, since the patient exhibited a concomitant hypersensitivity rash; and points out that delayed clearance of vancomycin in patients with chronic renal failure can produce late onset of side effects in such patients.