A Case of Hypersensitivity Syndrome to Both Vancomycin and Teicoplanin

Abstract

Drug hypersensitivity syndrome to both vancomycin and teicoplanin has not been previously reported. We describe here a 50-yr-old male patient with vertebral osteomyelitis and epidural abscess who developed hypersensitivity syndrome to both vancomycin and teicoplanin. Skin rash, fever, eosinophilia, interstitial pneumonitis, and interstitial nephritis developed following the administration of each drug, and resolved after withdrawing the drugs and treating with high dose corticosteroids. The vertebral osteomyelitis was successfully treated with 6-week course of linezolid without further complications. Skin patch tests for vancomycin and teicoplanin was done 2 months after the recovery; a weak positive result for vancomycin (10% aq.,+at D2 and +at D4 with erythema and vesicles; ICDRG scale), and a doubtful result for teicoplanin (4% aq.-at D2 and±at D4 with macular erythema; ICDRG scale). We present this case to alert clinicians to the hypersensitivity syndrome that can result from vancomycin and teicoplanin, with possible cross-reactivity, which could potentially be life-threatening.

High risk of cross-reactivity between vancomycin and sequential teicoplanin therapy

“…As vancomycin and teicoplanin share a similar glycopeptide structure, prior vancomycin intolerance may be the major precipitating factor for ADRs to subsequent teicoplanin therapy. Cross‐reactivity with regards to skin rash, fever, neutropenia and hypersensitivity syndrome has also been reported (2, 5–8).…”

“…Our hospital guidelines for MRSA identifies vancomycin as the first‐line choice for this indication and teicoplanin in cases of vancomycin intolerance. Some case reports have suggested the possibility of cross‐reactivity between the two antibiotics (2, 5–8), but few studies have examined the incidence of ADRs with sequential teicoplanin therapy following vancomycin. Our objective was to review data held in our drug‐use records to better define any cross‐reactivity between the two antibiotics.…”

Vancomycin-Induced DRESS Syndrome in a Female Patient

“…Vancomycin was the only causative agent, except in 1 case where teicoplanin was attributed to the relapse of DRESS syndrome [17] . Cross-reactivity between vancomycin and teicoplanin has also been reported in other adverse events [8,11,12,16] . All patients survived after the immediate withdrawal of the glycopeptides and administration of intravenous corticosteroids.…”

Vancomycin-Associated Spontaneous Cutaneous Adverse Drug Reactions

“…Vancomycin-induced anaphylaxis, an IgE-mediated immediate hypersensitivity reaction, is rare but does occur, and the readministration of vancomycin may cause bronchospasm or collapse in affected patients 4. Delayed hypersensitivity reactions caused by vancomycin can be manifested as DRESS syndrome, which is characterized by a skin rash, fever, eosinophilia, and visceral involvement (e.g., interstitial nephritis and hepatitis) 7,16-19. In our study, two patients showed a skin rash, fever, and eosinophilia, but no visceral involvement occurred in either case.…”