Vancomycin
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Drug fever: case report A 75-year-old man developed drug fever during treatment with vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia and cellulitis. The man was admitted to dermatology department of Ruijin hospital (China) in May 2019 with a chief complaint of systemic erythematous blisters for 2 months. He had a medical history of hypertension, type 2 diabetes, cerebral infarction and prostatic hyperplasia. On admission, he was diagnosed with bullous pemphigoid and started receiving treatment with halometasone and prednisone. On day 8 of admission, he had fever of 38.5°C. He was suspected to have cellulitis. He started receiving linezolid for suspected MRSA and cellulitis. On day 10, he had shortness of breath, cough, sputum and increased fever of 38.7°C. He was diagnosed with MRSA pneumonia and cellulitis. He continued to receive linezolid. After 5 days, he had persistent respiratory difficulties with a high-grade fever of 39°C and WBC count of 26.42 × 109/L. He developed sepsis and was intubated. On day 13, he was transferred to the respiratory ICU. He continued to receive linezolid for MRSA coverage. On day 15, linezolid was discontinued, and he started receiving vancomycin at 500mg every 12 hours [route not stated]. During the vancomycin treatment, he had a steady improvement in his condition with increased respiratory function. Also, the ruptured blisters were becoming dry and scabby. Despite the significant improvement of other clinical symptoms, he still experienced persistent high fever with increased eosinophil count in the blood. Thus, drug fever secondary to vancomycin was suspected [duration of treatment to reaction onset not stated]. Thus, on day 28 of admission, the man’s treatment with vancomycin was discontinued, following which his temperature returned to normal range within 24 hours. He re-started linezolid as a consolidation therapy. On day 33, he was afebrile and hemodynamically stable and his WBC count had reduced significantly to 7.08 × 109/L. Due to continued improvement in his general condition, his tracheostomy tube was successfully decannulated and the antibiotic therapy was completed on day 38. Then, he was transferred back to dermatology unit. Chen C, et al. Subtherapeutic linezolid concentration in a patient with bullous pemphigoid complicated by methicillin-resistant staphylococcus aureus infection: A case study. 803508160 Therapeutic Drug Monitoring 42: 515-517, No. 4, Aug 2020. Available from: URL: http://doi.org/10.1097/FTD.0000000000000758
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Reactions 17 Oct 2020 No. 1826
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