Uncommon Case of Oral Vancomycin Neurotoxicity With Sexual Dysfunction

We report a case of a 57-year-old male with a past medical history of controlled hypertension and type 2 diabetes mellitus, who had unusual elevated serum concentration levels of vancomycin during oral treatment for Clostridium difficile pseudomembranous colitis. Both measured serum vancomycin levels of 39 μg/ml and cerebrospinal fluid level of 5.7 μg/mL were documented and associated with unexplained neurological symptoms and sexual dysfunction. After discontinuing of oral vancomycin and treating with hemodialysis, the patient had reduced serum concentration levels to 26 μg/mL accompanied by significant and rapid resolution of symptoms in addition to the general condition. Patients with intestinal disease and reduced renal function who are being treated with oral vancomycin may absorb and accumulate high serum level amounts of vancomycin, causing uncommon neurological toxication symptoms including headache, altered state of consciousness, confusion, and drowsiness in association with sexual dysfunction.