Vancomycin vasculitis

Vasculitic rashes have been described rarely. Two case reports have suggested that there may be cross-reactivity between vancomycin and teicoplanin with respect to biopsy-proven leukocytoclastic vasculitis (91). In both cases, vancomycin-induced vasculitis improved after drug withdrawal. Teicoplanin was started and the rash reappeared several days later. In one case the rash faded after teicoplanin had been withdrawn. In the other, teicoplanin was continued, but the rash improved after prednisolone was given. 

Marshall C, Street A, Galbraith K. Glycopeptide-induced vasculitis—cross-reactivity between vancomycin and teico-planin. J Infect 1998 37(l) 82-3. 

A 76-year-old woman with penicillin and sulfa allergy was given vancomycin for a pacemaker infection with meticillin-sensi-tive S. aureus [98" ]. On day 4 she developed a worsening papular rash and a skin biopsy confirmed a severe leukocytoclastic necrotizing vasculitis, which resolved 5 days after vancomycin withdrawal. 

Felix-Getzik E, Sylvia LM. Vancomycin-induced leukocytoclastic vasculitis. Pharmacotherapy 2009 29(7) 846-51. 

A single case report of cutaneous vasculitis in association with oral vancomycin use for the treatment of C. difficile infection in an 86-year-old man [84 ]. One report of a localised bullous eruption resembling linear IgA bullous dermatosis was documented following extravasation of vancomycin [85 ]. 

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