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2025, Number 2

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Dermatología Cosmética, Médica y Quirúrgica 2025; 23 (2)

Stevens-Johnson syndrome secondary to vancomycin in a patient with chronic kidney disease

Manzano GP, González RG, García ÁS, García SMR, Galeana TR, Ordaz VE, García RK

Language: Spanish
References: 25
Page: 112-116
PDF size: 222.72 Kb.


ABSTRACT

Severe cutaneous adverse reactions to drugs are uncommon and associated with high mortality rates. Stevens-Johnson syndrome and toxic epidermal necrolysis are characterized by skin detachment and mucosal involvement, with drugs being a primary trigger. Common causative agents include trimethoprimsulfamethoxazole, phenytoin, and nonsteroidal anti-inflammatory drugs. Vancomycin is a rare cause of these reactions. We report a 53 year-old male with chronic kidney disease on replacement therapy who developed a hemodialysis catheter-associated infection requiring a 7-day vancomycin treatment. Subsequently, he developed skin lesions consistent with palpable purpura on the legs, followed by erythema and mucosal ulcerations in the mouth, eyes, and genitals, as well as erythema and maceration in skin folds. The diagnosis was vancomycin-associated Stevens-Johnson syndrome. The patient’s treatment involved discontinuation of vancomycin, fluid management, and methylprednisolone at 1 mg/kg/ day for five days, followed by intravenous immunoglobulin 2 g/ kg (total dose 150 g). Despite treatment, the patient’s condition worsened, and he died due to multisystem organ failure secondary to comorbidities.


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