Red man syndrome following the use of vancomycin-loaded bone cement in the primary total knee replacement: A case report

RATIONALE: Red man syndrome (RMS) is the most common allergic reaction to vancomycin. It generally occurs during rapid infusion of vancomycin; only few cases have been reported as results of local vancomycin administration. We hereby report a rare case where RMS developed after insertion of vancomycin-loaded bone cement in a primary total knee replacement (TKR). PATIENT CONCERNS: A 74-year-old woman was admitted for a left TKR due to severe osteoarthritis. Erythematous changes over face, trunk, and extremities developed after the use of vancomycin-loaded bone cement. DIAGNOSES: According to the clinical manifestations, the patient was diagnosed with vancomycin-induced RMS. INTERVENTIONS: She was treated with fluid challenge and intravenous ephedrine, followed by intravenous diphenhydramine and hydrocortisone. OUTCOMES: The patient's symptoms and signs relieved within 1 h after treatment. LESSONS: Vancomycin-induced RMS may occur after the routine use of vancomycin-loaded bone cement in the primary TKR replacement.