Vancomycin
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Linear IgA bullous dermatosis in an elderly patient: case report A 75-year-old man developed linear IgA bullous dermatosis during treatment with vancomycin for a methicillin-resistant Staphylococcus aureus (MRSA) infection of a hip prosthesis. The man, who had previously received vancomycin for a Staphylococcus epidermidis infection during the same hospital stay, started receiving IV vancomycin [dosage not stated] for an MRSA infection. Five days later, he developed blisters on his lower abdomen and lower extremities. Vancomycin was discontinued 2 days later, and the man was transferred to a dermatology clinic. On admission 4 days after blister onset, he exhibited cocardiform erythema with central blistering, and firm blisters on otherwise unremarkable skin; the skin changes affected his entire body, but predominantly his abdomen, lower back, thighs, palms and soles. Weeping erosions were noted at the same locations, but also affected his genital area and oral mucosa; his conjunctiva appeared red. StevensJohnson syndrome was suspected. Biopsy findings were suggestive of bullous pemphigoid. Linear IgA deposits in the basal membrane were noted on immunofluorescence, and circulating IgA auto antibodies against LAD-1 were identified on immunoblot. Linear IgA bullous dermatosis was diagnosed. He started receiving high-dose prednisolone, mouth washes, topical triclosan and fusidic acid for erosions on his trunk and extremities, and gentamicin for treatment of a Pseudomonas aeruginosa colonisation of his soles. After opening of the blisters, he developed extensive, predominantly dorsal and gluteal erosions and had to be placed on Metalline foil. Other treatment included volume substitution, analgesia, nadroparin calcium and ciprofloxacin. Daily whole-body baths were initiated as treatment of MRSA colonisation. No new blister formation was observed. The lesions started to heal after 4 weeks and subsequently completely resolved. Author comment: In the described case, blister formation developed during the repeated administration of vancomycin, and ceased 3 days after discontinuation of the suspect drug. Leclerque C, et al. Vancomycin-induced linear IgA disease. Aktuelle Dermatologie 37: 366-368, No. 10, 2011. Available from: URL: http://dx.doi.org/10.1055/ 803064247 s-0030-1256662 [German] - Germany
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Reactions 17 Dec 2011 No. 1382
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