Table 4.
Vancomycin Hepatotoxicity: 9 Cases
| Case | HLA-A (1) | HLA-A (2) | Rash | Fever | Eos | Renal | DRESS | DRESS score | Duration Therapy (days) | Time to Onset (days) | R value | Pattern | Peak Bilirubin | Severity Score | Causality Score |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | A*32:01 | A*32:01 | 1 | 1 | 1 | 1 | Yes | 8 | 37 | 20 | 28.2 | HC | 3.0 | 4 | 3 |
| 2 | A*25:01 | A*32:01 | 1 | 1 | 1 | 1 | Yes | 5 | 22 | 22 | 3.7 | Mix | 0.9 | 1 | 2 |
| 3 | A*02:01 | A*03:01 | 1 | 1 | 1 | 1 | Yes | 4 | 15 | 10 | 9.9 | HC | 1.9 | 3 | 3 |
| 4 | A*24:02 | A*24:02 | 0 | 0 | 0 | 0 | No | 1 | 1 | 6* | 0.6 | Chol | 14.3 | 2 | 3 |
| 5 | A*26:01 | A*32:01 | 1 | 1 | Unk | 1 | Yes | 3 | 26 | 27 | 3.4 | Mix | 19.4 | 4 | 3 |
| 6 | A*01:01 | A*32:01 | 1 | 1 | 1 | 1 | Yes | 5 | 31 | 20 | 0.8 | Chol | 0.7 | 1 | 2 |
| 7† | A*03:01 | A*32:01 | 1 | 1 | 1 | U | Yes | 5 | 18 | 16 | 0.2 | Chol | 3.3 | 3 | 3 |
| 8†** | A*32:01 | A*33:03 | 1 | 1 | 1 | 1 | Yes | 6 | 30 | 16 | 2.1 | Mix | 38.6 | 5 | 3 |
| 9† | A*01:01 | A*32:01 | 1 | 1 | 1 | 1 | Yes | 6 | 30 | 19 | 1.7 | Chol | 13.0 | 4 | 2 |
*
History of jaundice after previous exposure to vancomycin.
†
Initially concomitant medications thought to be an unlikely cause which on re-review was considered at least probable
**
African American, fatal outcome after re-exposure after onset of DRESS and acute exacerbation of liver and renal injury
Abbreviations: HLA, human leukocyte antigen; DRESS, drug-reaction eosinophilia and systemic symptoms; R = (ALT/ULN ÷ Alk P/ULN); ULN, upper limit of normal; HC, hepatocellular; Mix, mixed; Chol, cholestatic; Unk, unknown