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An Unexpected "Red Woman" with Oral Vancomycin
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A6594 - An Unexpected ""Red Woman"" with Oral Vancomycin
Author Block: W. Rodriguez, A. Cordero, D. Vazquez, O. Cantres-Fonseca; Pulm/CCM/Sleep, VA Caribbean Healthcare System, San Juan, PR, United States.
Vancomycin can cause several adverse reactions, the most common being “red man syndrome"" (RMS). RMS commonly presents with erythema and pruritus over the neck, face and upper body. This reaction usually occurs with parenteral administration of vancomycin in 3-5% of subjects.
A 54-year-old female with breast cancer on chemotherapy, asthma and type 2 diabetes mellitus was admitted to the intensive care unit due abdominal pain, fever and severe diarrhea causing hypotension and septic shock. Clostridium difficile toxin was positive and the patient was started on oral vancomycin 250 mg every 6 hours and intravenous metronidazole. An hour after the third dose of vancomycin she developed intensive pruritus, flushing, erythema of face, neck and chest similar to that of RMS. Vancomycin was discontinued and patient continued on rest of therapy. Prompt treatment with antihistamine medication and intravenous steroids were initiated with successful outcome within the next 6 hours. At 24 hours, erythema completely resolved.
Oral vancomycin is increasingly being used to treat Clostridium difficile infection. Vancomycin causes different adverse effects, including skin reactions and anaphylaxis. RMS is the most common of these adverse reactions and is usually associated with rapid intravenous infusion. Although RMS is rarely life threatening, it can lead to cardiovascular collapse due histamine release. Significant bowel inflammation can cause vancomycin to be absorbed to blood and cause reactions associated to intravenous administration. In this case we highlight that administration of oral vancomycin may pose a risk of systemic side effects such as RMS, thus close monitoring with first doses should be ensured.
Author Block: W. Rodriguez, A. Cordero, D. Vazquez, O. Cantres-Fonseca; Pulm/CCM/Sleep, VA Caribbean Healthcare System, San Juan, PR, United States.
Vancomycin can cause several adverse reactions, the most common being “red man syndrome"" (RMS). RMS commonly presents with erythema and pruritus over the neck, face and upper body. This reaction usually occurs with parenteral administration of vancomycin in 3-5% of subjects.
A 54-year-old female with breast cancer on chemotherapy, asthma and type 2 diabetes mellitus was admitted to the intensive care unit due abdominal pain, fever and severe diarrhea causing hypotension and septic shock. Clostridium difficile toxin was positive and the patient was started on oral vancomycin 250 mg every 6 hours and intravenous metronidazole. An hour after the third dose of vancomycin she developed intensive pruritus, flushing, erythema of face, neck and chest similar to that of RMS. Vancomycin was discontinued and patient continued on rest of therapy. Prompt treatment with antihistamine medication and intravenous steroids were initiated with successful outcome within the next 6 hours. At 24 hours, erythema completely resolved.
Oral vancomycin is increasingly being used to treat Clostridium difficile infection. Vancomycin causes different adverse effects, including skin reactions and anaphylaxis. RMS is the most common of these adverse reactions and is usually associated with rapid intravenous infusion. Although RMS is rarely life threatening, it can lead to cardiovascular collapse due histamine release. Significant bowel inflammation can cause vancomycin to be absorbed to blood and cause reactions associated to intravenous administration. In this case we highlight that administration of oral vancomycin may pose a risk of systemic side effects such as RMS, thus close monitoring with first doses should be ensured.
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