Vancomycin
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Linear IgA bullous dermatosis: case report A 67-year-old man developed linear IgA bullous dermatosis during treatment with vancomycin for polymicrobial pubic osteomyelitis and myositis. The man presented to the emergency department with a 1-day history of diffuse rash. He was diagnosed with polymicrobial pubic osteomyelitis and myositis from a urethral fistula, for which he started receiving treatment with vancomycin [dosage and route not stated] along with cefepime. Ten days following the initiation of vancomycin, he experienced a burning sensation on his tongue followed by the rapid development of erythematous patches with blistering involving legs, arms and abdomen. Physical examination revealed vesicles in the axilla (Panel A) and on the tongue (Panel B) and erythematous plaques with vesicles on legs, abdomen and arms. Histopathological examination of a biopsy specimen revealed neutrophilic papillitis with microvesicles (Panel C, hematoxylin and eosin). Direct immunofluorescence showed linear deposition of IgA along the basement membrane zone (Panel D). Based on these clinical presentation and findings, vancomycin-induced linear IgA bullous dermatosis was suspected. The man’s treatment with vancomycin was discontinued (while treatment with cefepime continued). One day after the withdrawal of vancomycin further lesions were not observed. At 1 month follow-up, complete resolution of the mucocutaneous lesions was observed. Raymond Go J, et al. Vancomycin-induced linear IgA bullous dermatosis. New England Journal of Medicine 383: 1577, No. 16, 15 Oct 2020. Available from: URL: http:// 803517240 doi.org/10.1056/NEJMicm2003334
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Reactions 28 Nov 2020 No. 1832
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