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Abstract

A case of Stevens-Johnson syndrome (SJS) is reported in a 64- year-old woman following 8 days of vancomycin for the treatment of a urinary tract infection with methicillin-resistant Staphylococcus aureus. Diffuse erythematous plaques with dusky centers confluent over the trunk, arms, and axillae, lesions of the oral mucosa, and conjunctiva involvement were present. Beta-lactam antibiotics, sulfa drugs, and anticonvulsants have the highest incidences of SJS. Cases of vancomycin-induced SJS have been reported in the literature. This patient received supportive care and systemic and topical corticosteroids. However, the efficacy and safety associated with the use of corticosteroids in the treatment of SJS remain controversial. Vancomycin has been associated with the development of SJS and the ability of corticosteroids to decrease morbidity, and slow the progression of lesions associated with SJS remains unclear.

Keywords

Stevens-Johnson syndrome vancomycin corticosteroids infusions intravenous drug therapy/adverse effects

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References

Odom RB , James WD , Berger TG . Andrews’ Diseases of the Skin Clinical Dermatology. 9th ed. Philadelphia, PA: WB Saunders Company; 2000.

RouJeau JC , Stern RS . Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331:1272-1279.

Habif TP . Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 3rd ed. St Louis, MO: Mosby-Year Book Inc; 1996.

Packer JP , Olshan AR , Schwartz AB . Prolonged allergic reaction to vancomycin in end-stage renal disease. Dial Transplant. 1987;16:86-88.

Laurencin CT , Horan RF , Senatus PB . Stevens-Johnson-type reaction with vancomycin treatment. Ann Pharmacother. 1992;26:1520-1521.

Alexander II , Greenberger PA . Vancomycin-induced Stevens-Johnson syndrome. Allergy Asthma Proc. 1996;17:75-78.

Vancocin® (vancomycin hydrochloride). In: Physician’s Desk Reference. 56th ed. Montvale, NJ: Medical Economics Company Inc; 2002:1970.

Reuf C , Blaser C. Miscellaneous antibacterial drugs: aminoglycosides, chloramphenicol, and thiamphenicol, fluoroquinolones, glycopeptides. In: Dukes MNG , Aronson JK , eds. Meyler’s Side Effects of Drugs: An Encyclopedia of Adverse Reactions and Interactions. 14th ed. Amsterdam: Elsevier Science; 2000:861.

Vancomycin hydrochloride . In: AHFS: Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2001:475.

10.

Polk RE , Healy DP , Schwarts LB , et al . Vancomycin and the redman syndrome: pharmacodynamics of histamine release. J Infect Dis. 1988;157:502-507.

11.

Patterson R , Dykewicz MS , Gonzales A , et al . Erythema multiforme and Stevens-Johnson syndrome. Chest. 1990;98: 331-336.

12.

Rasmussen JE . Erythema multiforme: should anyone care about the standards of care? Arch Dermatol. 1995;131:726-729.

13.

Garcia-Doval I , LeCleach L , Bocquet H , et al . Toxic epidermal necrolysis and Stevens-Johnson syndrome. Arch Dermatol. 2000;136:323-327.

14.

Weber DJ , Cohen MS , Fine J. The acutely ill patient with fever and rash. In: Mandell GL , Bennett JE , Dolin R , eds. Principles and Practice of Infectious Diseases. Vol 1, 5th ed. Philadelphia, PA: Churchill Livingstone; 2000:636.

15.

Patterson R , Miler M , Kaplan M , et al . Effectiveness of early therapy with corticosteroids in Stevens-Johnson syndrome: experience with 41 cases and a hypothesis regarding pathogenesis. Ann Allergy. 1994;73:27-34.

16.

Tripathi A , Ditto AM , Grammer LC , et al . Corticosteroid therapy in an additional thirteen cases of Stevens-Johnson syndrome: a total series of sixty seven cases. Allergy Asthma Proc. 2000; 21:101-105.

17.

Fine JD . Management of acquired bullous skin diseases. N Engl J Med. 1995;333:1475-1484.

18.

Roujeau JC . Treatment of severe drug eruptions. J Dermatol. 1999;26:718-722.

19.

Patterson R , Tripathi A. Stevens-Johnson syndrome: getting ready for the year 2000 and beyond. Ann Allergy Asthma Immunol. 1999;83:339-340.

20.

Charlesworth EN . Counterpoint to the use of systemic corticosteroids in the Stevens-Johnson syndrome. Ann Allergy Asthma Immunol. 2000;85:422.

21.

Stern RS . Improving the outcome of patients with toxic epidermal necrolysis and Stevens-Johnson syndrome. Arch Dermatol. 2000;136:410-411.

22.

Guibal F , Bastuji-Garin S , Chosidow O , et al . Characteristics of toxic epidermal necrolysis in patients undergoing long-term glucocorticoid therapy. Arch Dermatol. 1995;131:669-672.

Stevens-Johnson Syndrome Secondary to Vancomycin Exposure

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