Premium
Biopsy‐Proved Acute Tubulointerstitial Nephritis and Toxic Epidermal Necrolysis Associated with Vancomycin
Author(s) -
Hsu Stephen IHong
Publication year - 2001
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.21.15.1233.33901
Subject(s) - medicine , vancomycin , interstitial nephritis , rash , toxic epidermal necrolysis , eosinophilia , skin biopsy , nephritis , neutropenia , staphylococcus aureus , gastroenterology , dermatology , biopsy , pathology , kidney , chemotherapy , biology , bacteria , genetics
A 70‐year‐old man receiving vancomycin for a methicillin‐resistant Staphylococcus aureus (MRSA) abscess developed a drug‐induced hypersensitivity reaction with rash, eosinophilia, and acute renal failure requiring dialysis. Renal biopsy revealed diffuse and marked interstitial and tubular infiltration by mononuclear cells and eosinophils; acute tubulointerstitial nephritis (TIN) was diagnosed. The rash progressed to erythema multiforme major after rechallenge with vancomycin in the setting of MRSA peritoneal catheter‐related peritonitis and then to fatal toxic epidermal necrolysis in the setting of steroid taper and persistent serum vancomycin levels. This case further implicates vancomycin as a drug that infrequently can cause severe acute TIN and exfoliative dermatitis. When a renally excreted drug such as vancomycin is administered, serum drug levels should be serially monitored and high‐dosage steroids be maintained or tapered slowly until serum drug levels become undetectable.