Table 5.
Clinical data for cases of Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) to vancomycin (n=6)
| Age (yrs ) |
Sex (m/f ) |
Infection treated |
Reactio n timing* |
Rash description | Lab data | Biopsy | Treatment | Outcome | |
|---|---|---|---|---|---|---|---|---|---|
| Changela et al. 2013 |
35 | M | MRSA abscess |
9d | Dusky purpuric plaques and multiple fluid filled blisters on the trunk, upper and lower extremities. 30% of BSA |
IgA: 154mg/dL |
Necrotic epidermis Severe blisters at DE junction Necrotic keratocytes |
IV steroids for 4d Oral steroid taper |
Clinically improved |
| O’Brien et al. 2011 |
46 | F | Respiratory failure |
“few” d | Epidermal sloughing, erosions and blisters over 40% BSA. Nikolsky sign positive |
Epidermal necrosis, minimal interface, and perivascular lymphocytic infiltrate |
Discontinuatio n of vancomycin |
Terminally ill, deceased |
|
| Bouaziz et al. 2006 |
38 | F | Fistula | 9d | MP rash, fever, oral, ocular and mucous membrane erosions, diffuse blisters, Nikolsky sign positive, 50% epidermal skin detachment |
Serum drug level 20mg/L |
Follicular necrosis DE detachment |
IV fluids Anti-infectious therapy Nutritional support Skin care |
Deceased day 13, from HSR |
| Chan- Tack 2000 |
46 | F | Infected hip joint prosthesis |
8d | Diffuse flaccid bullae covering 50% BSA, necrotic epidermis. |
Epidermal necrosis and detachment |
Whirlpool therapy Topical antimicrobial Nutritional support Pain control |
Clinically improved, discharged after 8 weeks |
|
| Alexande r et al. 1996 |
36 | M | Endocarditi s |
17d | MP rash involving torso, abdomen, legs and arms. Lymphadenopathy , pharyngreal irritation, lip swelling, and conjunctival irritation. |
ANC: 1;911/mm3 Eosinophili a (13-28%) |
Epidermal necrosis DE junction blisters Dermal infiltration |
Steroid therapy | Clinical improvemen t within 24h |
| Vidal et al. 1992 |
28 | M |
S. aureus
sepsis (history of AIDS) |
27d | MP rash, fever, oral mucosa and genitals involved. Nikolsky’s sign positive |
ESR: 78mm/hour ANC: 1,349/mm3 |
Lymphocyti c and neutrophilic subdermal infiltration |
Switched therapy |
Recovered, discharged after 57d |
*
Timing from vancomycin dose to reaction onset
Abbreviations: MRSA: methicillin-resistant staphylococcus aureus; d: days; BSA: body surface area; DE: dermal-epidermal; IV: intravenous; MP: maculopapular; HSR: hypersensitivity reaction; ANC: absolute neutrophil count; AIDS: acquired immunodeficiency syndrome; ESR: erythrocyte sedimentation rate