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Title: Biopsy-proved acute tubulointerstitial nephritis and toxic epidermal necrolysis associated with vancomycin
Authors: Hsu, S.I.-H. 
Issue Date: 2001
Citation: Hsu, S.I.-H. (2001). Biopsy-proved acute tubulointerstitial nephritis and toxic epidermal necrolysis associated with vancomycin. Pharmacotherapy 21 (10 I) : 1233-1239. ScholarBank@NUS Repository.
Abstract: 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.
Source Title: Pharmacotherapy
ISSN: 02770008
Appears in Collections:Staff Publications

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