Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
Department of Dermatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
Asian Pac J Allergy Immunol. 2020 Mar;38(1):47-51. doi: 10.12932/AP-210518-0319.
Vancomycin (VCM) has been reported to elicit adverse cutaneous drug reactions. However, VCM-associated purpuric drug eruption has not been reported yet, except leukocytoclastic vasculitis. A 16-year-old Japanese girl was admitted with a respiratory infection. We initiated intravenous administration of VCM. After the start of treatment, impalpable purpuric eruption appeared on her trunk. The eruption gradually extended to her neck, legs, and arms. Skin biopsy showed vasculitis with lymphocyte infiltration in the superficial dermis. A drug lymphocyte stimulation test yielded positive results for VCM. Her cutaneous symptoms rapidly reversed after the withdrawal of VCM. To the best of our knowledge, this is the first reported case of VCM-associated purpuric drug eruption, which differs from leukocytoclastic vasculitis. We recommend that VCM-associated purpuric drug eruption should be considered in the differential diagnosis during the administration of VCM, and a drug lymphocyte stimulation test may be useful for assessment of pathogenesis.
万古霉素（VCM）已被报道会引起不良的皮肤药物反应。然而，除白细胞碎裂性血管炎外，尚未有 VCM 相关性紫癜性药物疹的报道。一名 16 岁的日本女孩因呼吸道感染入院。我们开始给予她万古霉素静脉滴注。治疗开始后，她的躯干出现了不可触及的紫癜性皮疹。皮疹逐渐扩展到她的颈部、腿部和手臂。皮肤活检显示真皮浅层血管炎伴淋巴细胞浸润。药物淋巴细胞刺激试验对万古霉素呈阳性结果。她的皮肤症状在停用万古霉素后迅速缓解。据我们所知，这是首例万古霉素相关性紫癜性药物疹的报道，与白细胞碎裂性血管炎不同。我们建议在给予万古霉素时应考虑其相关性紫癜性药物疹的鉴别诊断，药物淋巴细胞刺激试验可能有助于评估发病机制。
