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A Case of Oral-Vancomycin-Induced Rash in a Patient with Acute Kidney Injury

Clostridioides difficile infection (CDI) is one of the most common hospital-acquired infections. Its incidence has increased during the last decade in the community among individuals with no previous risk factors; however, morbidity and mortality are still considered high in elderly patients. Oral V...

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Autores principales: Cardozo, Milena, Parmar, Angadbir S., Rueda Prada, Libardo, Shweta, Fnu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137931/
https://www.ncbi.nlm.nih.gov/pubmed/37102979
http://dx.doi.org/10.3390/idr15020019
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author Cardozo, Milena
Parmar, Angadbir S.
Rueda Prada, Libardo
Shweta, Fnu
author_facet Cardozo, Milena
Parmar, Angadbir S.
Rueda Prada, Libardo
Shweta, Fnu
author_sort Cardozo, Milena
collection PubMed
description Clostridioides difficile infection (CDI) is one of the most common hospital-acquired infections. Its incidence has increased during the last decade in the community among individuals with no previous risk factors; however, morbidity and mortality are still considered high in elderly patients. Oral Vancomycin and Fidaxomicin are the first lines of treatment for CDI. The systemic bioavailability of oral Vancomycin is thought to be undetectable due to its poor absorption in the gastrointestinal tract; therefore, routine monitoring is not warranted. Only 12 case reports were found in the literature that described adverse reactions associated with oral Vancomycin and its related risk factors. We present a case of a 66-year-old gentleman with severe CDI and acute renal failure who was started on oral Vancomycin upon admission. On day five of treatment, he developed leukocytosis associated with neutrophilia, eosinophilia, and atypical lymphocytes, with no evidence of active infection. Three days later, he developed a pruritic maculopapular rash in more than 50% of his body surface area. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) was ruled out since the patient only had three inclusion criteria for this diagnosis. No clear inciting agent was found. Oral Vancomycin was stopped and supportive treatment was supplied for a presumed Vancomycin-induced allergic reaction. The patient had an excellent response, with complete resolution of the rash and leukocytosis in less than 48 h. By reporting this case, we want to raise awareness among clinicians to remember that, albeit rare, oral Vancomycin can be the cause of adverse drug reactions in patients with severe illnesses.
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spelling pubmed-101379312023-04-28 A Case of Oral-Vancomycin-Induced Rash in a Patient with Acute Kidney Injury Cardozo, Milena Parmar, Angadbir S. Rueda Prada, Libardo Shweta, Fnu Infect Dis Rep Case Report Clostridioides difficile infection (CDI) is one of the most common hospital-acquired infections. Its incidence has increased during the last decade in the community among individuals with no previous risk factors; however, morbidity and mortality are still considered high in elderly patients. Oral Vancomycin and Fidaxomicin are the first lines of treatment for CDI. The systemic bioavailability of oral Vancomycin is thought to be undetectable due to its poor absorption in the gastrointestinal tract; therefore, routine monitoring is not warranted. Only 12 case reports were found in the literature that described adverse reactions associated with oral Vancomycin and its related risk factors. We present a case of a 66-year-old gentleman with severe CDI and acute renal failure who was started on oral Vancomycin upon admission. On day five of treatment, he developed leukocytosis associated with neutrophilia, eosinophilia, and atypical lymphocytes, with no evidence of active infection. Three days later, he developed a pruritic maculopapular rash in more than 50% of his body surface area. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) was ruled out since the patient only had three inclusion criteria for this diagnosis. No clear inciting agent was found. Oral Vancomycin was stopped and supportive treatment was supplied for a presumed Vancomycin-induced allergic reaction. The patient had an excellent response, with complete resolution of the rash and leukocytosis in less than 48 h. By reporting this case, we want to raise awareness among clinicians to remember that, albeit rare, oral Vancomycin can be the cause of adverse drug reactions in patients with severe illnesses. MDPI 2023-03-30 /pmc/articles/PMC10137931/ /pubmed/37102979 http://dx.doi.org/10.3390/idr15020019 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Cardozo, Milena
Parmar, Angadbir S.
Rueda Prada, Libardo
Shweta, Fnu
A Case of Oral-Vancomycin-Induced Rash in a Patient with Acute Kidney Injury
title A Case of Oral-Vancomycin-Induced Rash in a Patient with Acute Kidney Injury
title_full A Case of Oral-Vancomycin-Induced Rash in a Patient with Acute Kidney Injury
title_fullStr A Case of Oral-Vancomycin-Induced Rash in a Patient with Acute Kidney Injury
title_full_unstemmed A Case of Oral-Vancomycin-Induced Rash in a Patient with Acute Kidney Injury
title_short A Case of Oral-Vancomycin-Induced Rash in a Patient with Acute Kidney Injury
title_sort case of oral-vancomycin-induced rash in a patient with acute kidney injury
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137931/
https://www.ncbi.nlm.nih.gov/pubmed/37102979
http://dx.doi.org/10.3390/idr15020019
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