Rare case of "red man" syndrome in a female patient treated with oral vancomycin for Clostridium difficile diarrhoea

Nallasivan, Subramanian; Maher, Fergus; Murthy, Krishna

doi:10.1136/bcr.03.2009.1705

Cited by 10 publications

(9 citation statements)

References 2 publications

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“…Red man syndrome is a drug hypersensitivity reaction to vancomycin that can occur in 5 to 14% of adults [70]. It typically occurs when vancomycin is administered parenterally, but there have been case reports of red man syndrome occurring when vancomycin is administered orally [71,72,73]. The syndrome usually involves symptoms of pruritus, flushing and an erythematous rash that involves the upper body and neck [74].…”

Section: Vancomycinmentioning

confidence: 99%

Nonallergic Drug Hypersensitivity Reactions

Farnam

Chang

Teuber

et al. 2012

Int Arch Allergy Immunol

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Background: Nonallergic drug hypersensitivities, also referred to as pseudoallergic or anaphylactoid reactions, have clinical manifestations that are often indistinguishable from allergic reactions. Methods: We performed a PubMed search using the terms ‘drug allergy, drug hypersensitivity, pseudoallergies, anaphylaxis and nonallergic drug reactions’ and reviewed 511 publications dated between 1970 and 2012. A total of 160 papers that were relevant to the most common nonallergic drug hypersensitivity reactions were selected for discussion. Results: Nonallergic drug hypersensitivities do not involve either IgE-mediated (type 1) or delayed (type 4) hypersensitivity. Nonallergic hypersensitivities are commonly referred to as pseudoallergic or idiosyncratic reactions. The common nonallergic drug hypersensitivities are secondary to chemotherapeutic drugs, radiocontrast agents, vancomycin, nonsteroidal anti-inflammatory agents, local anesthetic reactions and opiates. Protocols for skin testing of radiocontrast, nonsteroidal anti-inflammatory agents, local anesthetics and chemotherapeutic agents have been developed, though most have not been validated or standardized. Other diagnostic tests include in vitro-specific IgE tests, and the current ‘gold’ standard is usually an oral challenge or bronchoprovocation test. In the case of aspirin, even though it is not believed to be IgE-mediated, a ‘desensitization’ protocol has been developed and utilized successfully, although the mechanism of this desensitization is unclear. Conclusions: Diagnostic methods exist to distinguish allergic from nonallergic drug hypersensitivity reactions. The best option in nonallergic drug hypersensitivity is avoidance. If that is not possible, premedication protocols have been developed, although the success of premedication varies amongst drugs and patients.

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Section: Vancomycinmentioning

confidence: 99%

Nonallergic Drug Hypersensitivity Reactions

Farnam

Chang

Teuber

et al. 2012

Int Arch Allergy Immunol

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“…Fortunately, except for one patient with serious underlying diseases and a poor prognosis after taking vancomycin orally for a long period of time, 25 all of the other 15 patients achieved good outcomes after stopping vancomycin and/or receiving other treatments. 11,16,19,20,23,24,27–34…”

Section: Discussionmentioning

confidence: 99%

“…26 The main clinical manifestations of IgE-mediated hypersensitivity induced by oral vancomycin are local or systemic maculopapule and urticaria. 26 Table 1 and Table 2 present a summary and analysis of the case reports (including this current case) of the adverse reactions caused by oral vancomycin, 11,16,19,20,[23][24][25][27][28][29][30][31][32][33][34] which can occur at ages ranging from 2 months to 82 years (median age, 59 years). Skin changes were the most common (13 of 16 patients; 81.3%).…”

Section: Discussionmentioning

confidence: 99%

A rare case of infant eosinophilia induced by oral vancomycin: a case report and literature review

Yin

Guo

et al. 2023

J Int Med Res

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Oral vancomycin is mainly used to treat and prevent active Clostridium difficile infection. Because it is widely believed that there is a very low absorption rate via the gastrointestinal tract, reports of adverse reactions following oral vancomycin administration are rare. This case report describes for the first time a case of antibiotic-associated diarrhoea in a 2-month-old infant treated with oral vancomycin. After oral vancomycin treatment, the number of eosinophils increased significantly and the levels gradually recovered after drug withdrawal. A review and analysis of the previously reported adverse reactions caused by oral vancomycin and eosinophilia caused by vancomycin confirm the need for physicians to pay close attention to vancomycin-related adverse reactions, to monitor the required concentration and to measure eosinophil counts in patients with rash-related adverse reactions. Patients with concomitant diseases and children should be monitored for adverse events as it is possible that they have increased gastrointestinal absorption of vancomycin following oral administration. When vancomycin causes eosinophilia, fever and rash, physicians should be alert to the possibility of organ damage.

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“…Nevertheless, the high dose of VCM induced a high serum VCM concentration (3.9 μg/mL). The systemic absorption of oral VCM is known to cause adverse effects, including maculopapular rashes (15,16), red man syndrome (13,17,18), anaphylaxis (19), leukopenia (14) and encephalopathy (20). Based on these findings and the patient's clinical course, we suspected that he developed the maculopapular rash secondary to VCM (21).…”

Section: Discussionmentioning

confidence: 99%

Continuous Administration of Vancomycin through a Long Intestinal Tube for <i>Clostridium difficile</i> Infection

et al. 2015

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A 76-year-old previously healthy Japanese man experienced severe diarrhea (8,000 mL per day) after undergoing laparotomy for small bowel obstruction and was diagnosed with Clostridium difficile infection. Although he developed a maculopapular rash secondary to the systemic absorption of enteral vancomycin (VCM), the patient was successfully treated with the continuous administration of VCM through a long intestinal tube placed in the terminal ileum. This method ensured the reliable delivery of VCM to the colon, while the continuous administration maintained high fecal levels of the drug. This treatment approach is an effective minimally invasive option for patients with severe diarrhea.

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Rare case of "red man" syndrome in a female patient treated with oral vancomycin for Clostridium difficile diarrhoea

Cited by 10 publications

References 2 publications

Nonallergic Drug Hypersensitivity Reactions

Nonallergic Drug Hypersensitivity Reactions

A rare case of infant eosinophilia induced by oral vancomycin: a case report and literature review

Continuous Administration of Vancomycin through a Long Intestinal Tube for <i>Clostridium difficile</i> Infection

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