Fecha de recepción: 12/04/2018 – Fecha de aceptación: 24/05/2018
Hernández-Guío A1, Bernabeu-Martínez MA1, Martínez-Lazcano MT1, Vera-Álvarez S2
1 Servicio de Farmacia
2 Servicio de Dermatología
Hospital General Universitario San Juan de Alicante. Alicante (España)
Ana Hernández Guío w Hospital General Universitario San Juan de Alicante (Servicio de Farmacia) w Ctra. Nnal. 332, s/n w 03550 Sant Joan d’Alacant. Alicante (España)
Introduction: Vancomycin is one of the oldest antibiotics used for the treatment of gram positive infections. The most frequent adverse effects found are nephrotoxicity, ototoxicity, “Red man syndorme” and hematologic toxic effects. Although it is important to know other adverse effects less known and exceptional, such as linear IgA bullous dermatosis.
We present a case of infection of a hip prosthesis that developed linear IgA bullous dermatosis due to vancomycin.
Case presentation: An 84-year-old male developed a surgical wound infection due to methicillin-resistant Staphylococcus aureus secondary to hip arthroplasty, which started treatment with intravenous vancomycin. After 10 days of treatment, he presented with a generalized vesiculobullous eruption, with vesicles annularly arranged in a “string of pearls”, that began in the perineal area and spread to the rest of the trunk and extremities. After evaluation by the Dermatology Service and in the case of suspected linear IgA dermatosis secondary to vancomycin, treatment was discontinued, the appearance of new lesions ceasing and gradual improvement of existing ones, leaving erosions and residual hyperpigmentation. The diagnosis was confirmed by direct immunofluorescence technique in skin biopsies.
Conclusion: Because vancomycin is a drug widely used in clinical practice and linear IgA bullous dermatosis is a little known, but potentially, serious adverse effect, its knowledge is crucial for an early diagnosis and to reduce the associated morbidity and mortality.
Key Words: Linear IgA bullous dermatosis, drug-related side effects and adverse reactions, vancomycin, drug hypersensitivity, skin diseases, vesiculobullous, anti-bacterial agents.