Diffuse Desquamating Rash Following Exposure to Vancomycin-Impregnated Bone Cement

Williams, Brett; Hanson, Amy; Sha, Beverly E.

doi:10.1177/1060028014529547

Cited by 22 publications

(10 citation statements)

References 22 publications

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“…To our knowledge, this is only the third case of DRESS syndrome described to occur in patients with retained antibiotic-impregnated cement spacers, with one additional study identifying a case of Stevens-Johnson syndrome in a patient with antibiotic cement spacer [5] . Although drug reactions in general are common, occurring in up to 15% of hospitalized patients [6] , severe drug reactions like the one described in this article are exceedingly rare.…”

Section: Discussionmentioning

confidence: 80%

Drug reaction with eosinophilia and systemic symptoms syndrome after total knee arthroplasty infection and placement of antibiotic spacer

Harper

Incavo

2019

Arthroplasty Today

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Though 2-stage revision is considered the gold standard in North America for treatment of periprosthetic joint infection, complications can be associated with use of antibiotic-impregnated spacers. We present a unique case of drug reaction with eosinophilia and systemic symptoms syndrome in a patient with retained antibiotic-impregnated spacer placed for the treatment of a periprosthetic joint infection. Although drug reactions in general are common, severe drug reactions like the one described in this article are exceedingly rare. After discontinuation of intravenous antibiotics and the initiation of corticosteroids, the patient’s symptoms resolved, despite retention of the spacer. Steroid administration and supportive care may result in resolution of symptoms without the need for surgical intervention for spacer removal.

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Section: Discussionmentioning

confidence: 80%

Drug reaction with eosinophilia and systemic symptoms syndrome after total knee arthroplasty infection and placement of antibiotic spacer

Harper

Incavo

2019

Arthroplasty Today

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“…In addition to AKI, serious cutaneous reactions have been attributed to vancomycin ALBC. Williams et al [10] reported the development of a desquamating rash after implantation of vancomycin ALBC in a patient with a history of vancomycin-induced Stevens-Johnson syndrome.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Local Inflammatory Reaction to Vancomycin-Laden Bone Cement

YoungHeather

MillerWhitney

WilsonMichael

et al. 2016

Surgical Infections Case Reports

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Background: Antibiotic-laden bone cement is used commonly for fixation of primary hip arthroplasty and in the creation of spacers for treatment of orthopedic infections. We report an adverse event associated with the use of a vancomycin-laden bone cement spacer for treatment of a total knee arthroplasty infection. Case Presentation: A 60-year old Hispanic male developed chronic total knee arthroplasty infection caused by coagulase-negative staphylococci and anaerobic bacteria. He received systemic vancomycin and a vancomycinladen cement spacer. During treatment, the patient developed a macular rash that resolved with discontinuation of intravenous vancomycin. He completed a six-week course of antibiotics uneventfully. When the patient returned to the operating room for revision arthroplasty, substantial local inflammation was found in the frozen sections. The vancomycin-laden cement spacer was removed and replaced with a spacer that did not contain vancomycin. No organisms were found on either routine microbiologic culture or broad-range polymerasechain reaction studies. The Naranjo nomogram showed a ''probable'' adverse drug reaction to vancomycin cement. The patient received six more weeks of broad-spectrum antibiotics and eventually underwent successful revision arthroplasty. Conclusion: We believe that this patient had systemic and local allergic reactions to vancomycin. Because antibiotic-laden bone cement and other topical antibiotic preparations are used commonly in the treatment of surgical infections, we encourage providers to be aware of the possible adverse effects.

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“…28 This patient became symptomatic 44 days after the spacer was implanted. Other antibiotic-impregnated spacers, beads, and bone cement have been associated with postoperative complications, including isolated cutaneous eruption, 29 hypersensitivity reactions, 21 drug fever, 30 and acute kidney injury. 31,32 DRESS is extremely uncommon, with an estimated incidence of 1 out of every 10,000 individuals exposed to an implicated medication.…”

Section: Discussionmentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms Associated with a Vancomycin-Impregnated Spacer

et al. 2015

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction with a mortality rate near 10% characterized by erythematous cutaneous eruption, multiorgan involvement, and hypereosinophilia. This case report highlights a patient who developed DRESS in the setting of intravenous vancomycin and a vancomycin and tobramycin-impregnated (PROSTALAC, DePuy Synthes, Warsaw, IN) functional spacer. The spacer was placed during the revision of a left total knee replacement complicated by a septic joint. To our knowledge, this is the third reported case of DRESS associated with vancomycin-impregnated spacers. As DRESS is a potentially life-threatening reaction and the principal treatment is withdrawal of the precipitating drug, it is important to consider this clinical entity and discontinue all forms of the causative agent. Patients with DRESS may develop a diffuse cutaneous eruption, respiratory failure, acute kidney injury, elevated liver enzymes, lymphadenopathy, and/or hemodynamic instability following intravenous infusion of antibiotics or placement of antibiotic-impregnated spacers, beads, or bone cement. Interestingly, this patient had a prominent and progressive erythematous eruption surrounding the left knee that improved after operative removal of the spacer. At 6?week hospital follow-up, the patient's systemic signs and symptoms had essentially resolved.

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Diffuse Desquamating Rash Following Exposure to Vancomycin-Impregnated Bone Cement

Cited by 22 publications

References 22 publications

Drug reaction with eosinophilia and systemic symptoms syndrome after total knee arthroplasty infection and placement of antibiotic spacer

Drug reaction with eosinophilia and systemic symptoms syndrome after total knee arthroplasty infection and placement of antibiotic spacer

Local Inflammatory Reaction to Vancomycin-Laden Bone Cement

Drug Reaction with Eosinophilia and Systemic Symptoms Associated with a Vancomycin-Impregnated Spacer

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