SUMMARYWhat is known and Objective: Teicoplanin is a glycopeptide antibiotic used against documented or presumed methicillin-resistant infections. We report a 31-month-old boy with acute lymphocytic leukaemia who developed permanent complete atrioventricular block (CAVB) necessitating pacemaker insertion after receiving teicoplanin for Staphylococcus epidermidis bacteremia. Case summary: Clinical assessment of the child revealed febrile neutropenia. After thorough assessment and work-up, the patient was started on teicoplanin intravenously after which he had sudden onset of bradycardia. Electrocardiography showed CAVB that eventually required permanent pacemaker insertion. Twenty-nine months from the incident, the patient is doing well. What is new and Conclusion: We report on a case of teicoplanin-associated CAVB in a child with acute lymphoblastic leukaemia (ALL). This is one of only two similar cases reported in the literature. Teicoplanin remains the most probable cause. The use of teicoplanin should be approached cautiously in the setting of immunosuppression. Whether VZV contributed and teicoplanin triggered remains speculative. Physicians should be aware of this possible complication.
WHAT IS KNOWN AND OBJECTIVETeicoplanin is a glycopeptide antibiotic used against methicillinresistant gram-positive infections.1 It is generally well tolerated at therapeutic doses.2 Complete atrioventricular block (CAVB) induced by teicoplanin has been reported once in the literature. 3 We report another case of teicoplanin-induced CAVB in a child with acute lymphoblastic leukaemia (ALL). To the best of our knowledge, only one other similar case has been reported.
DETAILS OF THE CASEA 31-month-old boy diagnosed at the age of 16 months with intermediate-risk T-cell ALL presented to the hospital for maintenance chemotherapy week #51 that consisted of 6-mercaptopurine (6-MP) at a dose of 60 mg/m 2 /day and methotrexate at 40 mg/ m 2 /week. Clinical assessment of the child on admission revealed febrile neutropenia which prevented the patient's receipt of the recommended chemotherapy. Fever work-up including blood cultures was performed, and the patient was discharged after receiving a single dose of ceftriaxone intravenously. Three days later, blood cultures showed coagulase-negative, gram-positive cocci identified as Staphylococcus epidermidis and the child was called for further management.On presentation, the patient was stable and in no acute distress. His vital signs were as follows: temperature of 36AE2°C, heart rate of 126 bpm, respiratory rate of 26 breaths per minute and blood pressure of 101/50 mmHg with 100% oxygen saturation. His electrocardiography (EKG) showed normal sinus rhythm. After re-evaluation of the patient and based on his previous studies and blood cultures, he was started on teicoplanin intravenously at a dose of 10 mg/kg twice daily. Fifteen hours later, there was sudden onset of bradycardia with the heart rate reaching 45 bpm. There was no obvious clinical distress, and cardiac examination revealed nor...