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Hypersensitivity syndrome following allergic cross reaction: case report A 58-year-old man developed hypersensitivity syndrome following allergic cross reaction between teicoplanin and vancomycin during treatment of Corynebacterium striata infection or Staphylococcus aureus infection. The man was admitted to the hospital on 11 December 2018 due to diabetic foot ulcer on the right side for more than a month. After admission, his wound culture was indicative of C. striata infection. Hence, he started receiving IV vancomycin 1g every 12 hours. On Day 3 after admission, a deep wound expansion (DWE) of the right foot was performed. After the operation, vacuum sealing drainage (VSD) treatment was started. On day 16, he was discharged on levofloxacin treatment. On 15 January 2019, he was readmitted due to purulence and ulceration of the wound of his right foot. The microbial culture of the wound was indicative of methicillin-resistant S. aureus and C. striata. On day 3 of readmission, he underwent DWE surgery of the right foot, and the tissue of the wound was sent for general pathological examination. Following surgery, he was started on IV teicoplanin 0.4g twice per day. On the third day of the surgery, pathological examination was indicative of right-foot squamous cell carcinoma (keratin type). On day 10, he underwent an extended resection of the squamous cell carcinoma, followed by right foot mesh skin graft using skin from the anterolateral side of his ipsilateral lower leg. From the morning of the second day after the skin graft, he developed recurrent fever (over 39°C). His blood was collected for microbiological culture, and his inflammatory indicators were monitored. The man was started on anal embolisation with indometacin and physical cooling. Laboratory tests showed WBC of 4.9 × 109/L, RBC of 3.57 × 1012/L, platelet of 165 × 109/L, neutrophils of 0.666, eosinophils of 0.002, lymphocytes of 0.199, procalcitonin of 0.18 ng/mL and C-reactive protein of 22.3 mg/L. The skin graft was well attached with no SC effusion or suppuration and no swelling or redness around the wound. On day 12, he developed facial flushing, which spread to his back and faciocervical part on the next day. Initially, it was patchy, which then joined into a piece with slight bulge in some area, and but no obvious itching was observed. On day 14, his infectious disease physician suggested that infection could not be ruled out, and discontinuation of teicoplanin was recommended. Hence, his treatment was changed from teicoplanin to oral linezolid 600mg twice a day. On the same day, liver function tests revealed AST of 51 U/L and ALT of 70 U/L. On day 16 of readmission, his flushing persisted, but skin rashes on the trunk were significantly improved. He continued to have fever up to 39°C and above, and a significant decrease in his nutritional indicators was observed with low serum sodium level. He was started on symptomatic treatment. Laboratory tests showed WBC of 3.2 × 109/L, RBC of 3.45 × 1012/L, platelet of 26 × 109/L, neutrophils of 0.6