We describe a 51-year-old patient with endstage renal disease who developed vancomycin-associated exfoliative dermatitis. After four weeks of vancomycin hydrochloride treatment for staphylococcal pericarditis this patient developed a hypersensitivity reaction characterized by intermittent fevers, lymphadenopathy, peripheral eosinophilia, and exfoliative dermatitis. The reaction persisted for five weeks, probably because of inability to rapidly eliminate vancomycin secondary to underlying renal failure. Maculopapular rashes have been reported in two to six percent of patients who receive this drug, with severe skin reactions rarely reported. In addition to this case report, a review of the literature including 11 Eli Lilly/Food and Drug Administration case reports is presented. Although severe skin reactions to vancomycin rarely occur, they prolong morbidity, particularly in patients with renal failure.
A 79-year-old white male was admitted to the hospital for treatment of a right-lower-lobe pneumonia. His past medical history included: mild congestive heart failure, asymptomatic ventricular tachycardia, and ethanol abuse. He was initially treated with furosemide for his heart failure, lidocaine for his arrhythmias, and Bactrim for his pneumonia. On day 13 of hospitalization he experienced a tonic-clonic seizure during the time he was being converted from lidocaine to tocainide. At the time of the seizure both tocainide and lidocaine were well within their respective therapeutic ranges. Since the seizure, the patient has tolerated treatment with each drug separately, and at serum concentrations similar to those preceding the seizure, without neurological complications, indicating the possibility of a tocainide-lidocaine induced seizure.
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