Drug-induced linear IgA bullous dermatosis after vancomycin discontinuance in a patient with renal insufficiency,☆☆,

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Abstract

Linear IgA bullous dermatosis (LABD) is an autoimmune, subepidermal, vesiculobullous disease that has been commonly associated with the use of vancomycin hydrochloride. Lesions typically appear during vancomycin therapy, 24 hours to 15 days after the first dose. A 65-year-old white man with renal insufficiency developed pruritic, tense bullae on the right chest, right medial arm, right flank, abdomen, and right upper thigh 14 days after his last dose of vancomycin. Histopathologic examination and immunofluorescence studies were diagnostic of LABD. Vancomycin-related LABD may appear as long as 2 weeks after the drug is discontinued. (J Am Acad Dermatol 2000;42:316-23.)

Section snippets

CASE REPORT

A 65-year-old man was admitted to Kings Daughters Hospital (Madison, Ind) after an acute anteroseptal myocardial infarction. He was subsequently transferred to Jewish Hospital (Louisville, Ky) for evaluation for cardiac surgery. His past medical history included a previous myocardial infarction, hypertension, hypercholesterolemia, and chronic obstructive pulmonary disease. Medications on admission were clonidine hydrochloride and hydrochlorothiazide.

Three days after transfer, he underwent an

DISCUSSION

LABD is an autoimmune subepidermal vesiculobullous disease that is characterized histopathologically by the linear deposition of IgA at the BMZ. Multiple medications have been implicated as potential etiologies of drug-induced LABD (Table II).5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30

We report a 65-year-old man with sepsis and renal failure, who developed LABD 14 days after receiving his last dose of vancomycin. Of 8 reported cases, all but

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    This supplement is made possible through an educational grant from Ortho Dermatological to the American Academy of Dermatology.

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